<section article="ghg" article_name="Health - General" number="15-101" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this title the following words have the meanings indicated.</text> </level> <level label="a–1"> <text>“Dental managed care organization” means a pre–paid dental plan that receives fees to manage dental services.</text> </level> <level label="a–2"> <text>“Dental services” means diagnostic, emergency, preventive, and therapeutic services for oral diseases.</text> </level> <level label="b"> <text>“Enrollee” means a program recipient who is enrolled in a managed care organization.</text> </level> <level label="b–1"> <text>“Expedited eligibility” means a streamlined eligibility process, conducted by the local health departments, for medical assistance for children and pregnant women under which an eligibility determination is made promptly, but not later than 10 working days after the date of application.</text> </level> <level label="c"> <text>“Facility” means a hospital or nursing facility including an intermediate care facility, skilled nursing facility, comprehensive care facility, or extended care facility.</text> </level> <level label="d"> <text>“Former foster care adolescent” means an individual:</text> <level label="1"> <text>Who is under 26 years of age; and</text> </level> <level label="2"> <text>Who, on the individual’s 18th birthday, was in foster care under the responsibility of the State, any other state, or the District of Columbia.</text> </level> </level> <level label="d–1"> <level label="1"> <text>“Historic provider” means a health care provider, as defined in § 19–132 of this article, or a residential service agency licensed under Title 19, Subtitle 4A of this article, that, on or before June 30, 1995, had a demonstrated history of providing services to program recipients, as defined by the Department in regulations.</text> </level> <level label="2"> <text>“Historic provider”, to the extent the provider meets the requirements in paragraph (1) of this subsection, shall include:</text> <level label="i"> <text>A federal or State qualified community health center;</text> </level> <level label="ii"> <text>A provider with a program for the training of health care professionals, including an academic medical center;</text> </level> <level label="iii"> <text>A hospital outpatient program, physician, or advanced practice nurse that is a Maryland Access to Care (MAC) provider;</text> </level> <level label="iv"> <text>A local health department;</text> </level> <level label="v"> <text>A hospice, as defined in Title 19, Subtitle 9 of this article;</text> </level> <level label="vi"> <text>A pharmacy; and</text> </level> <level label="vii"> <text>Any other historic provider designated in accordance with regulations adopted by the Department.</text> </level> </level> </level> <level label="e"> <text>“Managed care organization” means:</text> <level label="1"> <text>A certified health maintenance organization that is authorized to receive medical assistance prepaid capitation payments; or</text> </level> <level label="2"> <text>A corporation that:</text> <level label="i"> <text>Is a managed care system that is authorized to receive medical assistance prepaid capitation payments;</text> </level> <level label="ii"> <text>Enrolls only program recipients or individuals or families served under the Maryland Children’s Health Program; and</text> </level> <level label="iii"> <text>Is subject to the requirements of § 15–102.4 of this subtitle.</text> </level> </level> </level> <level label="f"> <text>“Ombudsman program” means a program that assists enrollees in resolving disputes with managed care organizations in a timely manner and that is responsible, at a minimum, for the following functions:</text> <level label="1"> <text>Investigating disputes between enrollees and managed care organizations referred by the enrollee hotline;</text> </level> <level label="2"> <text>Reporting to the Department:</text> <level label="i"> <text>The resolution of all disputes;</text> </level> <level label="ii"> <text>A managed care organization’s failure to meet the Department’s requirements; and</text> </level> <level label="iii"> <text>Any other information specified by the Department;</text> </level> </level> <level label="3"> <text>Educating enrollees about:</text> <level label="i"> <text>The services provided by the enrollee’s managed care organization; and</text> </level> <level label="ii"> <text>The enrollee’s rights and responsibilities in receiving services from the managed care organization; and</text> </level> </level> <level label="4"> <text>Advocating on behalf of the enrollee before the managed care organization, including assisting the enrollee in using the managed care organization’s grievance process.</text> </level> </level> <level label="g"> <text>“Primary mental health services” means the clinical evaluation and assessment of services needed by an individual and the provision of services or referral for additional services as deemed medically appropriate by a primary care provider.</text> </level> <level label="h"> <text>“Program” means the Maryland Medical Assistance Program.</text> </level> <level label="i"> <text>“Program recipient” means an individual who receives benefits under the Program.</text> </level> <level label="j"> <text>“Self–measured blood pressure monitoring” means the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere, requiring the use of a home blood pressure measurement device by the patient.</text> </level> <level label="k"> <text>“Special pediatric hospital” means a facility in the State that provides nonacute medical, rehabilitation, therapy, and palliative services to individuals:</text> <level label="1"> <text>Under the age of 22 years; or</text> </level> <level label="2"> <text>Who are at least 2 years old and under the age of 23 years and have co–occurring physical and behavioral health conditions.</text> </level> </level> <level label="l"> <text>“Specialty mental health services” means any mental health services other than primary mental health services.</text> </level> <level label="m"> <text>“Validated home blood pressure monitor” means a blood pressure measurement device that has been validated for accuracy and is listed in the U.S. Blood Pressure Validated Device Listing.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-101.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>Except as otherwise provided in this subtitle, a managed care organization is not subject to the insurance laws of the State or to the provisions of Title 19 of this article.</text> </level> <level label="b"> <text>A managed care organization may not be required to offer a qualified plan, as defined in § 31–101 of the Insurance Article, in the Maryland Health Benefit Exchange.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-102" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>Subject to the limitations of the State budget, the Department shall provide preventive and home care services for indigent and medically indigent individuals.</text> </level> <level label="b"> <level label="1"> <text>The Program shall promote educational opportunities for recipients on:</text> <level label="i"> <text>Preventive health care;</text> </level> <level label="ii"> <text>Good health habits; and</text> </level> <level label="iii"> <text>The value of developing ongoing relationships with primary care and lower cost providers.</text> </level> </level> <level label="2"> <text>In educating Program recipients in accordance with the provisions of paragraph (1) of this subsection, the Program shall work with appropriate groups to assist in the education of Program recipients.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-102.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The General Assembly finds that it is a goal of this State to promote the development of a health care system that provides adequate and appropriate health care services to indigent and medically indigent individuals.</text> </level> <level label="b"> <text>The Department shall, to the extent permitted, subject to the limitations of the State budget:</text> <level label="1"> <text>Provide a comprehensive system of quality health care services with an emphasis on prevention, education, individualized care, and appropriate case management;</text> </level> <level label="2"> <text>Develop a prenatal care program for Program recipients and encourage its utilization;</text> </level> <level label="3"> <text>Allocate State resources for the Program to provide a balanced system of health care services to the population served by the Program;</text> </level> <level label="4"> <text>Seek to coordinate the Program activities with other State programs and initiatives that are necessary to address the health care needs of the population served by the Program;</text> </level> <level label="5"> <text>Promote Program policies that facilitate access to and continuity of care by encouraging:</text> <level label="i"> <text>Provider availability throughout the State;</text> </level> <level label="ii"> <text>Consumer education;</text> </level> <level label="iii"> <text>The development of ongoing relationships between Program recipients and primary health care providers; and</text> </level> <level label="iv"> <text>The regular review of the Program’s regulations to determine whether the administrative requirements of those regulations are unnecessarily burdensome on Program providers;</text> </level> </level> <level label="6"> <text>Ensure access to and the continuity of services provided by family planning providers that were family planning providers in the Program as of December 31, 2024, and were discontinued as recipients of federal funding under federal law or regulation because of the scope of services offered by the provider or the scope of services for which the provider offered referrals, by:</text> <level label="i"> <text>Reimbursing for the Program services provided; and</text> </level> <level label="ii"> <text>Establishing Program requirements for the family planning providers that:</text> <level label="1"> <text>Are similar to the requirements for other providers of the same services;</text> </level> <level label="2"> <text>Do not prohibit a provider from offering a service if the service is within the scope of practice of the provider as established under the Health Occupations Article; and</text> </level> <level label="3"> <text>Do not limit the scope of services for which a provider may offer referrals;</text> </level> </level> </level> <level label="7"> <text>Strongly urge health care providers to participate in the Program and thereby address the needs of Program recipients;</text> </level> <level label="8"> <text>Require health care providers who participate in the Program to provide access to Program recipients on a nondiscriminatory basis in accordance with State and federal law;</text> </level> <level label="9"> <text>Seek to provide appropriate levels of reimbursement for providers to encourage greater participation by providers in the Program;</text> </level> <level label="10"> <text>Promote individual responsibility for maintaining good health habits;</text> </level> <level label="11"> <text>Encourage the Program and Maryland’s health care regulatory system to work to cooperatively promote the development of an appropriate mix of health care providers, limit cost increases for the delivery of health care to Program recipients, and ensure the delivery of quality health care to Program recipients;</text> </level> <level label="12"> <text>Encourage the development and utilization of cost–effective and preventive alternatives to the delivery of health care services to appropriate Program recipients in inpatient institutional settings;</text> </level> <level label="13"> <text>Encourage the appropriate executive agencies to coordinate the eligibility determination, policy, operations, and compliance components of the Program;</text> </level> <level label="14"> <text>Work with representatives of inpatient institutions, third party payors, and the appropriate State agencies to contain Program costs;</text> </level> <level label="15"> <text>Identify and seek to develop an optimal mix of State, federal, and privately financed health care services for Program recipients, within available resources through cooperative interagency efforts;</text> </level> <level label="16"> <text>Develop joint Legislative and Executive Branch strategies to persuade the federal government to reconsider those policies that discourage the delivery of cost–effective health care services to Program recipients;</text> </level> <level label="17"> <text>Evaluate departmental recommendations as to those persons whose financial need or health care needs are most acute;</text> </level> <level label="18"> <text>Establish mechanisms for aggressively pursuing recoveries against third parties permitted under current law and exploring additional methods for seeking to recover other money expended by the Program;</text> </level> <level label="19"> <text>Take appropriate measures to assure the quality of health care services provided by managed care organizations; and</text> </level> <level label="20"> <text>Develop a process for providing information about the availability of the State’s earned income tax credit established under § 10–704 of the Tax – General Article to each Program enrollee or potential Program enrollee when providing information about the Program.</text> </level> </level> <level label="c"> <level label="1"> <text>The Department shall collaborate with the Office of the Comptroller or the Office of the State Treasurer to:</text> <level label="i"> <text>Form a one–sentence statement advising that individuals who cannot afford health insurance may be eligible to enroll in a medical assistance program; and</text> </level> <level label="ii"> <text>Print the statement formed under item (i) of this paragraph:</text> <level label="1"> <text>On each State–issued tax refund check stub;</text> </level> <level label="2"> <text>Once each pay quarter, on each State–issued employee paycheck stub; and</text> </level> <level label="3"> <text>On each State–issued child support payment check stub.</text> </level> </level> </level> <level label="2"> <text>The statement shall include a telephone number or other contact information that an individual may use to receive more information on eligibility for medical assistance programs.</text> </level> <level label="3"> <text>The statement may be altered by the Department in collaboration with the Office of the Comptroller or the Office of the State Treasurer to:</text> <level label="i"> <text>Provide the most current information;</text> </level> <level label="ii"> <text>Fit within the space constraints of the different types of checks listed in paragraph (1)(ii) of this subsection; or</text> </level> <level label="iii"> <text>Combine it with the statement required under § 15–304(c) of this title, if appropriate.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-102.2" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>Except as otherwise provided in this section, the provisions of § 19-706.1 of this article (Rehabilitation and liquidation) shall apply to managed care organizations in the same manner they apply to health maintenance organizations.</text> </level> <level label="b"> <level label="1"> <text>A health care provider may not assert a claim of subrogation against an enrollee of a managed care organization or the State.</text> </level> <level label="2"> <text>Notwithstanding paragraph (1) of this subsection, a health care provider may assert any claim it may have against the receiver of the insolvent managed care organization.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-102.3" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The provisions of § 15–112(b)(1)(ii) and (2), (f) through (m), (r), (s), and (u) through (w) of the Insurance Article (Provider panels) shall apply to managed care organizations in the same manner they apply to carriers.</text> </level> <level label="b"> <text>The provisions of § 15–1005 of the Insurance Article shall apply to managed care organizations in the same manner they apply to health maintenance organizations.</text> </level> <level label="c"> <text>The provisions of §§ 4–311, 15–604, and 15–605 of the Insurance Article shall apply to managed care organizations in the same manner they apply to carriers.</text> </level> <level label="d"> <level label="1"> <text>The provisions of §§ 19–712(b), (c), and (d), 19–713.2, and 19–713.3 of this article apply to managed care organizations in the same manner they apply to health maintenance organizations.</text> </level> <level label="2"> <text>The Insurance Commissioner shall consult with the Secretary before taking any action against a managed care organization under this subsection.</text> </level> </level> <level label="e"> <text>The provisions of § 15–112.1 of the Insurance Article apply to managed care organizations in the same manner they apply to carriers.</text> </level> <level label="f"> <text>The Insurance Commissioner or an agent of the Commissioner shall examine the financial affairs and status of each managed care organization at least once every 5 years.</text> </level> <level label="g"> <text>The provisions of § 15–1628.3 of the Insurance Article apply to pharmacy benefits managers that contract with managed care organizations in the same manner as they apply to pharmacy benefits managers that contract with carriers.</text> </level> <level label="h"> <level label="1"> <text>The provisions of § 6–102.1 of the Insurance Article apply to managed care organizations.</text> </level> <level label="2"> <text>For each calendar year that the Insurance Commissioner assesses a health insurance provider fee under § 6–102.1 of the Insurance Article, a managed care organization shall pay the fee on a quarterly basis in accordance with a schedule adopted by the Insurance Commissioner.</text> </level> </level> <level label="i"> <text>The provisions of §§ 15–130 and 15–130.1 of the Insurance Article apply to managed care organizations and pharmacy benefits managers that contract with managed care organizations.</text> </level> <level label="j"> <text>The provisions of § 33–105(f) of the Insurance Article apply to managed care organizations.</text> </level> <level label="k"> <level label="1"> <text>To the extent authorized under federal law and subject to paragraph (2) of this subsection, the provisions of § 15–1008(a), (b), (c)(1) and (2)(i), (d), (e), and (f) of the Insurance Article shall apply to managed care organizations in the same manner they apply to carriers.</text> </level> <level label="2"> <text>If a retroactive denial of reimbursement is the result of coordination of benefits, a written statement provided by a managed care organization to a health care provider in accordance with § 15–1008(c)(2)(i) of the Insurance Article shall include the name and address of the entity identified by the managed care organization as responsible for payment of the claim.</text> </level> </level> <level label="l"> <text>Beginning July 1, 2025, the provisions of § 15–859 of the Insurance Article apply to managed care organizations in the same manner they apply to carriers.</text> </level> <level label="m"> <text>Beginning January 1, 2026, the provisions of § 15–862 of the Insurance Article apply to managed care organizations in the same manner that they apply to carriers.</text> </level> <level label="n"> <text>The provisions of § 15–863 of the Insurance Article apply to managed care organizations in the same manner they apply to carriers.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-102.4" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>Each managed care organization shall be actuarially sound.</text> </level> <level label="2"> <level label="i"> <text>Except as otherwise provided in this section, the surplus that a managed care organization is required to have shall be paid in full.</text> </level> <level label="ii"> <text>A managed care organization shall have an initial surplus that exceeds the liabilities of the managed care organization by at least $1,500,000.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>In consultation with the Secretary, the Insurance Commissioner may adjust the initial surplus requirement for a managed care organization that is not licensed as a health maintenance organization. In determining whether to make an adjustment under this paragraph, the Commissioner shall consider:</text> <level label="i"> <text>The proposed capitation level that would be received by the managed care organization under a contract with the Department under this subtitle;</text> </level> <level label="ii"> <text>The proposed range of benefits to be provided under a contract with the Department under this subtitle;</text> </level> <level label="iii"> <text>The existence of any commitment by the Secretary to designate funds over and above the proposed capitation where the designated funds:</text> <level label="1"> <text>Are equivalent to the difference between the requirements of § 19–710 of this article and any lower requirements determined by the Commissioner under this subparagraph; and</text> </level> <level label="2"> <text>Would be available in case of the impairment or insolvency of the managed care organization; and</text> </level> </level> <level label="iv"> <text>The availability of the money held in trust by the Secretary to pay claims in case of impairment or insolvency of the managed care organization.</text> </level> </level> <level label="2"> <text>Notwithstanding subsection (a)(2)(ii) of this section, a managed care organization shall have an initial surplus that exceeds liabilities by at least $1,250,000. If a managed care organization has an initial surplus that is at least $1,250,000 but less than $1,500,000, prior to approval, the Department shall designate funds under paragraph (1)(iii) of this subsection sufficient to provide an initial surplus of at least $1,500,000.</text> </level> </level> <level label="c"> <level label="1"> <level label="i"> <text>Each managed care organization shall maintain a surplus that exceeds the liabilities of the managed care organization in the amount that is at least equal to the greater of $750,000 or 5 percent of the subscription charges earned during the prior calendar year as recorded in the annual report filed by the managed care organization with the Commissioner.</text> </level> <level label="ii"> <text>No managed care organization shall be required to maintain a surplus in excess of a value of $3,000,000.</text> </level> </level> <level label="2"> <level label="i"> <text>For the protection of the managed care organization’s enrollees and creditors, the applicant shall deposit and maintain in trust with the State Treasurer $100,000 in cash or government securities of the type described in § 5–701(b) of the Insurance Article.</text> </level> <level label="ii"> <level label="1"> <text>The deposits shall be accepted and held in trust by the State Treasurer in accordance with the provisions of Title 5, Subtitle 7 of the Insurance Article.</text> </level> <level label="2"> <text>For the purpose of applying this subparagraph, a managed care organization shall be treated as an insurer.</text> </level> </level> </level> </level> <level label="d"> <text>Each managed care organization shall comply with risk based capital standards in accordance with regulations adopted by the Insurance Commissioner under § 4–311 of the Insurance Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-102.5" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>Subject to § 15–103.1(dd) of this subtitle, a health maintenance organization that requires its panel providers to participate in a managed care organization shall establish a mechanism, subject to review by the Secretary, which provides for equitable distribution of enrollees and which ensures that a provider will not be assigned a disproportionate number of enrollees.</text> </level> <level label="b"> <text>Nothing in this section may be interpreted as prohibiting a provider from voluntarily accepting additional enrollees.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-102.6" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>Subject to paragraph (2) of this subsection, the provisions of Title 7 of the Insurance Article apply to managed care organizations.</text> </level> <level label="2"> <text>Before approving a transaction under § 7–306 of the Insurance Article, the Insurance Commissioner shall consult with the Secretary.</text> </level> <level label="3"> <text>The Insurance Commissioner:</text> <level label="i"> <text>Shall adopt regulations establishing a reporting materiality threshold; and</text> </level> <level label="ii"> <text>May adopt regulations necessary to implement the provisions of this subsection.</text> </level> </level> <level label="4"> <text>The provisions of this subsection may not apply to any transaction preempted by federal law.</text> </level> </level> <level label="b"> <text>The provisions of Title 4, Subtitle 5 of the Insurance Article apply to managed care organizations.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-102.7" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The premium tax imposed under § 6-102 of the Insurance Article applies to managed care organizations.</text> </section> <section article="ghg" article_name="Health - General" number="15-102.8" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Department may impose a claims processing charge on all Medicaid claims processed, approved, and paid by the Department to hospitals located in the District of Columbia for the provision of inpatient and outpatient hospital services.</text> </level> <level label="b"> <text>The amount to be paid under subsection (a) of this section may not exceed 6% of the amount of claims paid.</text> </level> <level label="c"> <text>The Department shall adopt regulations to implement this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-103" future_version_removed="true" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Secretary shall administer the Maryland Medical Assistance Program.</text> </level> <level label="b"> <text>The Program:</text> <level label="1"> <text>Subject to the limitations of the State budget, shall provide medical and other health care services for indigent individuals or medically indigent individuals or both;</text> </level> <level label="2"> <text>Shall provide, subject to the limitations of the State budget and as permitted by federal law, comprehensive medical, dental, and other health care services, including services provided in accordance with § 15–141.5 of this subtitle, for all eligible pregnant women whose family income is at or below 250% of the poverty level for the duration of the pregnancy and for 1 year immediately following the end of the woman’s pregnancy;</text> </level> <level label="3"> <text>Shall provide, subject to the limitations of the State budget and as permitted by federal law, comprehensive medical and other health care services for all eligible children currently under the age of 1 year whose family income falls below 185% of the poverty level;</text> </level> <level label="4"> <text>Beginning on January 1, 2012, shall provide, subject to the limitations of the State budget and as permitted by federal law, family planning services to all women whose family income is at or below 200% of the poverty level;</text> </level> <level label="5"> <text>Shall provide, subject to the limitations of the State budget and as permitted by federal law, comprehensive medical and other health care services for all children who are at least 1 year old and under the age of 5 years whose family income falls below 133% of the poverty level;</text> </level> <level label="6"> <text>Beginning on January 1, 2014, shall provide, subject to the limitations of the State budget and as permitted by federal law, comprehensive medical care and other health care services for all children who are at least 6 years old and under the age of 19 years whose family income falls below 133% of the poverty level;</text> </level> <level label="7"> <text>Shall provide, subject to the limitations of the State budget and as permitted by federal law, comprehensive medical care and other health care services for all legal immigrants who meet Program eligibility standards and who arrived in the United States before August 22, 1996, the effective date of the federal Personal Responsibility and Work Opportunity Reconciliation Act;</text> </level> <level label="8"> <text>Shall provide, subject to the limitations of the State budget and any other requirements imposed by the State, comprehensive medical care and other health care services for all legal immigrant children under the age of 18 years and pregnant women who meet Program eligibility standards and who arrived in the United States on or after August 22, 1996, the effective date of the federal Personal Responsibility and Work Opportunity Reconciliation Act;</text> </level> <level label="9"> <text>Beginning on January 1, 2014, shall provide, subject to the limitations of the State budget, and as permitted by federal law, medical care and other health care services for adults whose annual household income is at or below 133% of the poverty level;</text> </level> <level label="10"> <text>Subject to the limitations of the State budget, and as permitted by federal law:</text> <level label="i"> <text>Shall provide comprehensive medical care, dental care, and other health care services for former foster care adolescents who, on their 18th birthday, were in foster care under the responsibility of the State and are not otherwise eligible for Program benefits; and</text> </level> <level label="ii"> <text>May provide comprehensive medical care, dental care, and other health care services for former foster care adolescents who, on their 18th birthday, were in foster care under the responsibility of any other state or the District of Columbia;</text> </level> </level> <level label="11"> <text>May include bedside nursing care for eligible Program recipients;</text> </level> <level label="12"> <text>Shall provide services in accordance with funding restrictions included in the annual State budget bill;</text> </level> <level label="13"> <text>Beginning on January 1, 2023, shall provide, subject to the limitations of the State budget, and as permitted by federal law, dental services for adults, including diagnostic, preventive, restorative, and periodontal services, whose annual household income is at or below 133 percent of the federal poverty level;</text> </level> <level label="14"> <text>Shall provide, subject to the limitations of the State budget, medically appropriate drugs that are approved by the United States Food and Drug Administration for the treatment of hepatitis C, regardless of the fibrosis score, and that are determined to be medically necessary;</text> </level> <level label="15"> <text>Shall provide, subject to the limitations of the State budget, health care services appropriately delivered through telehealth to a patient in accordance with § 15–141.2 of this subtitle;</text> </level> <level label="16"> <text>Beginning on January 1, 2021, shall provide, subject to the limitations of the State budget and § 15–855(b)(2) of the Insurance Article, and as permitted by federal law, services for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including the use of intravenous immunoglobulin therapy, for eligible Program recipients, if pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome are coded for billing and diagnosis purposes in accordance with § 15–855(d) of the Insurance Article;</text> </level> <level label="17"> <text>Beginning on January 1, 2022, may not include, subject to federal approval and limitations of the State budget, a frequency limitation on covered dental prophylaxis care or oral health exams that requires the dental prophylaxis care or oral health exams to be provided at an interval greater than 120 days within a plan year;</text> </level> <level label="18"> <text>Shall provide, subject to the limitations of the State budget, comprehensive medical care and other health care services to noncitizen pregnant women who would be eligible for the Program but for their immigration status and to their children up to the age of 1 year;</text> </level> <level label="19"> <text>Shall provide coverage of abortion care services to Program recipients in the manner described in § 15–857(b)(1)(ii) and (2) of the Insurance Article;</text> </level> <level label="20"> <text>Beginning on July 1, 2023, shall provide, subject to federal approval and limitations of the State budget, community violence prevention services in accordance with § 15–141.3 of this subtitle;</text> </level> <level label="21"> <text>Beginning on January 1, 2023, shall provide, subject to the limitations of the State budget, and as permitted by federal law, coverage for self–measured blood pressure monitoring for all Program recipients diagnosed with uncontrolled high blood pressure, including:</text> <level label="i"> <text>The provision of validated home blood pressure monitors; and</text> </level> <level label="ii"> <text>Reimbursement of health care provider and other staff time used for patient training, transmission of blood pressure data, interpretation of blood pressure readings and reporting, and the delivery of co–interventions, including educational materials or classes, behavioral change management, and medication management;</text> </level> </level> <level label="22"> <text>Beginning on January 1, 2024, shall provide gender–affirming treatment in accordance with § 15–151 of this subtitle;</text> </level> <level label="23"> <text>Beginning on July 1, 2025, shall provide, subject to the limitations of the State budget, and as permitted by federal law, coverage for biomarker testing in accordance with § 15–859 of the Insurance Article;</text> </level> <level label="24"> <text>Beginning on January 1, 2025, shall provide coverage for prostheses in accordance with § 15–844 of the Insurance Article;</text> </level> <level label="25"> <text>Beginning on January 1, 2026, shall provide, subject to the limitations of the State budget, and as permitted by federal law, coverage for self–measured blood pressure monitoring for eligible Program recipients in accordance with § 15–141.6 of this subtitle;</text> </level> <level label="26"> <text>Beginning on January 1, 2026, shall provide coverage for a transfer to a special pediatric hospital in accordance with § 15–158 of the Insurance Article;</text> </level> <level label="27"> <text>Beginning on January 1, 2026, if providing coverage for the delivery of anesthesia, shall provide coverage for the delivery of anesthesia in accordance with § 15–862 of the Insurance Article;</text> </level> <level label="28"> <text>Beginning on January 1, 2026, shall provide calcium score testing in accordance with § 15–863 of the Insurance Article; and</text> </level> <level label="29"> <text>Beginning on January 1, 2027, may provide comprehensive coverage for the treatment of obesity under § 15–160 of this subtitle.</text> </level> </level> <level label="c"> <text>Subject to restrictions in federal law or waivers, the Department may:</text> <level label="1"> <text>Impose cost–sharing on Program recipients; and</text> </level> <level label="2"> <text>For adults who do not meet requirements for a federal category of eligibility for Medicaid:</text> <level label="i"> <text>Cap enrollment; and</text> </level> <level label="ii"> <text>Limit the benefit package.</text> </level> </level> </level> <level label="d"> <text>Subject to the limitations of the State budget, the Department shall implement the provisions of Title II of the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010, to include:</text> <level label="1"> <text>Parents and caretaker relatives who have a dependent child living in the parents’ or caretaker relatives’ home; and</text> </level> <level label="2"> <text>Adults who do not meet requirements, such as age, disability, or parent or caretaker relative of a dependent child, for a federal category of eligibility for Medicaid and who are not enrolled in the federal Medicare program, as enacted by Title XVII of the Social Security Act.</text> </level> </level> <level label="e"> <level label="1"> <text>On or before January 1, 2025, subject to the limitations of the State budget, and as permitted by federal law, the Department:</text> <level label="i"> <text>Shall establish an Express Lane Eligibility Program to enroll individuals in the Program and Maryland Children’s Health Program based on eligibility findings by the Supplemental Nutrition Assistance Program;</text> </level> <level label="ii"> <text>May not consider any other income or eligibility requirements;</text> </level> <level label="iii"> <text>To the extent that a waiver is needed to maximize the number of State residents who may qualify for the Express Lane Eligibility Program, shall apply to the Centers for Medicare and Medicaid Services for one or more waivers under § 1115 of the federal Social Security Act to implement the Express Lane Eligibility Program; and</text> </level> <level label="iv"> <text>Subject to paragraph (2) of this subsection, shall make all reasonable efforts to expedite enrollment of eligible individuals in the Express Lane Eligibility Program.</text> </level> </level> <level label="2"> <text>The Department may propose or implement the use of Express Lane Eligibility for renewals before proposing or implementing the use of Express Lane Eligibility for initial enrollment.</text> </level> </level> <level label="f"> <level label="1"> <text>The Department shall ensure that payments for services provided by a hospital located in a contiguous state or in the District of Columbia to an enrollee under the Program shall be reduced by 20% if the hospital fails to submit discharge data on all Maryland patients receiving care in the hospital to the Health Services Cost Review Commission in a form and manner the Commission specifies.</text> </level> <level label="2"> <text>Paragraph (1) of this subsection does not apply to a hospital that presently provides discharge data to the public in a form the Health Services Cost Review Commission determines is satisfactory.</text> </level> </level> <level label="g"> <level label="1"> <level label="i"> <text>In this subsection the following words have the meanings indicated.</text> </level> <level label="ii"> <text>“Certified nurse practitioner” means a registered nurse who is licensed in this State, has completed a nurse practitioner program approved by the State Board of Nursing, and has passed an examination approved by that Board.</text> </level> <level label="iii"> <text>“Nurse anesthetist” means a registered nurse who is:</text> <level label="1"> <text>Certified under the Health Occupations Article to practice nurse anesthesia; and</text> </level> <level label="2"> <text>Certified by the Council on Certification or the Council on Recertification of Nurse Anesthetists.</text> </level> </level> <level label="iv"> <text>“Nurse midwife” means a registered nurse who is licensed in this State and has been certified by the American College of Nurse–Midwives as a nurse midwife.</text> </level> <level label="v"> <text>“Optometrist” has the meaning stated in § 11–101 of the Health Occupations Article.</text> </level> </level> <level label="2"> <text>The Secretary may contract for the provision of care under the Program to eligible Program recipients.</text> </level> <level label="3"> <text>The Secretary may contract with insurance companies or nonprofit health service plans or with individuals, associations, partnerships, incorporated or unincorporated groups of physicians, chiropractors, dentists, podiatrists, optometrists, pharmacists, hospitals, nursing homes, nurses, including nurse anesthetists, nurse midwives and certified nurse practitioners, opticians, and other health practitioners who are licensed or certified in this State and perform services on the prescription or referral of a physician.</text> </level> <level label="4"> <text>For the purposes of this section, the nurse midwife need not be under the supervision of a physician.</text> </level> <level label="5"> <text>Except as otherwise provided by law, a contract that the Secretary makes under this subsection shall continue unless terminated under the terms of the contract by the Program or by the provider.</text> </level> </level> <level label="h"> <text>As permitted by federal law or waiver, the Secretary may administer the Medicare Option Prescription Drug Program, established under § 15–124.3 of this subtitle, as part of the Maryland Medical Assistance Program.</text> </level> <level label="i"> <text>By regulation, the Department shall adopt a methodology to ensure that federally qualified health centers are paid reasonable cost–based reimbursement that is consistent with federal law.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-103.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>As permitted by federal law or waiver, the Secretary may establish a program under which Program recipients are required to enroll in managed care organizations.</text> </level> <level label="b"> <level label="1"> <text>The benefits required by the program developed under subsection (a) of this section shall be:</text> <level label="i"> <text>Adopted by regulation; and</text> </level> <level label="ii"> <text>At least equivalent to the benefit level required by the Program on January 1, 1996.</text> </level> </level> <level label="2"> <text>Subject to the limitations of the State budget and as permitted by federal law or waiver, the Department shall provide reimbursement for medically necessary and appropriate inpatient, intermediate care, and halfway house substance use disorder treatment services for enrollees at least 21 years old with substance use disorders who are recipients of temporary cash assistance under the Family Investment Program.</text> </level> <level label="3"> <text>Each managed care organization participating in the program developed under subsection (a) of this section shall provide or arrange for the provision of the benefits described in paragraph (2) of this subsection.</text> </level> <level label="4"> <text>This subsection may not be construed to prohibit a managed care organization from offering additional benefits if the managed care organization is not receiving capitation payments based on the provision of the additional benefits.</text> </level> <level label="5"> <text>Notwithstanding paragraph (1) of this subsection, the benefits required by the program developed under subsection (a) of this section shall include dental services for pregnant women.</text> </level> </level> <level label="c"> <text>Subject to the limitations of the State budget and as permitted by federal law or waiver, the program developed under subsection (a) of this section may provide guaranteed eligibility for each enrollee for up to 6 months unless an enrollee obtains health insurance through another source.</text> </level> <level label="d"> <level label="1"> <text>The Secretary may exclude specific populations or services from the program developed under subsection (a) of this section.</text> </level> <level label="2"> <text>For any populations or services excluded under this subsection, the Secretary may authorize a managed care organization to provide the services or provide for the population, including authorization of a separate dental managed care organization or a managed care organization to provide services to Program recipients with special needs.</text> </level> </level> <level label="e"> <level label="1"> <text>Except for a service excluded by the Secretary under subsection (d) of this section, each managed care organization shall provide all the benefits required by regulations adopted under subsection (b) of this section.</text> </level> <level label="2"> <text>For a population or service excluded by the Secretary under subsection (d) of this section, the Secretary may authorize a managed care organization to provide only for that population or provide only that service.</text> </level> <level label="3"> <text>A managed care organization may subcontract specified required services to a health care provider that is licensed or authorized to provide those services.</text> </level> </level> <level label="f"> <text>Except for the Program of All–Inclusive Care for the Elderly (“PACE”) Program, the Secretary may not include the long–term care population or long–term care services in the program developed under subsection (a) of this section.</text> </level> <level label="g"> <text>The program developed under subsection (a) of this section shall ensure that enrollees have access to a pharmacy that:</text> <level label="1"> <text>Is licensed in the State; and</text> </level> <level label="2"> <text>Is within a reasonable distance from the enrollee’s residence.</text> </level> </level> <level label="h"> <text>For cause, the Department may disenroll enrollees from a managed care organization and enroll them in another managed care organization.</text> </level> <level label="i"> <level label="1"> <text>Each managed care organization shall:</text> <level label="i"> <text>Have a quality assurance program in effect that is subject to the approval of the Department and that, at a minimum:</text> <level label="1"> <text>Complies with any health care quality improvement system developed by the Centers for Medicare and Medicaid Services;</text> </level> <level label="2"> <text>Complies with the quality requirements of applicable State licensure laws and regulations;</text> </level> <level label="3"> <text>Complies with practice guidelines and protocols specified by the Department;</text> </level> <level label="4"> <text>Provides for an enrollee grievance system, including an enrollee hotline;</text> </level> <level label="5"> <text>Provides for a provider grievance system;</text> </level> <level label="6"> <text>Provides for enrollee and provider satisfaction surveys, to be taken at least annually;</text> </level> <level label="7"> <text>Provides for a consumer advisory board to receive regular input from enrollees;</text> </level> <level label="8"> <text>Provides for an annual consumer advisory board report to be submitted to the Secretary; and</text> </level> <level label="9"> <text>Complies with specific quality, access, data, and performance measurements adopted by the Department for treating enrollees with special needs;</text> </level> </level> <level label="ii"> <text>Submit to the Department:</text> <level label="1"> <text>Service–specific data by service type in a format established by the Department;</text> </level> <level label="2"> <text>Utilization and outcome reports, such as the Health Plan Employer Data and Information Set (HEDIS), as directed by the Department; and</text> </level> <level label="3"> <text>At least semiannually, aggregate data that includes:</text> </level> <level label="A"> <text>The number of enrollees provided with substance use disorder treatment services; and</text> </level> <level label="B"> <text>The amount of money spent on substance use disorder treatment;</text> </level> </level> <level label="iii"> <text>Promote timely access to and continuity of health care services for enrollees;</text> </level> <level label="iv"> <text>Demonstrate organizational capacity to provide special programs, including outreach, case management, and home visiting, tailored to meet the individual needs of all enrollees;</text> </level> <level label="v"> <text>Provide assistance to enrollees in securing necessary health care services;</text> </level> <level label="vi"> <text>Provide or ensure substance use disorder treatment for pregnant women with substance use disorders and all other enrollees of the managed care organization who require these services;</text> </level> <level label="vii"> <text>Educate enrollees on health care prevention and good health habits;</text> </level> <level label="viii"> <text>Ensure necessary provider capacity in all geographic areas under contract;</text> </level> <level label="ix"> <text>Be accountable and hold its subcontractors accountable for standards established by the Department and, on failure to meet those standards, be subject to one or more of the following penalties:</text> <level label="1"> <text>Fines;</text> </level> <level label="2"> <text>Suspension of further enrollments;</text> </level> <level label="3"> <text>Withholding of all or part of the capitation payment;</text> </level> <level label="4"> <text>Termination of the contract;</text> </level> <level label="5"> <text>Disqualification from future participation in the Program; and</text> </level> <level label="6"> <text>Any other penalties that may be imposed by the Department;</text> </level> </level> <level label="x"> <text>Subject to applicable federal and State law, include incentives for enrollees to comply with provisions of the managed care organization;</text> </level> <level label="xi"> <text>Provide or arrange to provide primary mental health services;</text> </level> <level label="xii"> <text>Provide or arrange to provide all Medicaid–covered services required to comply with State statutes and regulations mandating health and mental health services for children in State–supervised care:</text> <level label="1"> <text>According to standards set by the Department; and</text> </level> <level label="2"> <text>Locally, to the extent the services are available locally;</text> </level> </level> <level label="xiii"> <text>Submit to the Department aggregate information from the quality assurance program, including complaints and resolutions from the enrollee and provider grievance systems, the enrollee hotline, and enrollee satisfaction surveys;</text> </level> <level label="xiv"> <text>Maintain as part of the enrollee’s medical record the following information:</text> <level label="1"> <text>The basic health risk assessment conducted on enrollment;</text> </level> <level label="2"> <text>Any information the managed care organization receives that results from an assessment of the enrollee conducted for the purpose of any early intervention, evaluation, planning, or case management program;</text> </level> <level label="3"> <text>Information from the local department of social services regarding any other service or benefit the enrollee receives, including assistance or benefits from a program administered by the Department of Human Services under the Human Services Article; and</text> </level> <level label="4"> <text>Any information the managed care organization receives from a school–based clinic, a core services agency, a local health department, or any other person that has provided health services to the enrollee;</text> </level> </level> <level label="xv"> <text>On provision of information specified by the Department under subsection (r)(3) of this section, pay school–based clinics for services provided to the managed care organization’s enrollees;</text> </level> <level label="xvi"> <text>In coordination with participating dentists, enrollees, and families of enrollees, develop a process to arrange to provide dental therapeutic treatment to individuals under the age of 21 years that requires:</text> <level label="1"> <text>A participating dentist to notify a managed care organization when an enrollee is in need of therapeutic treatment and the dentist is unable to provide the treatment;</text> </level> <level label="2"> <text>The managed care organization to provide the enrollee or the family of the enrollee with a list of participating providers who offer therapeutic dental services; and</text> </level> <level label="3"> <text>The managed care organization to notify the enrollee or the family of the enrollee that the managed care organization will provide further assistance if the enrollee has difficulty obtaining an appointment with a provider of therapeutic dental services;</text> </level> </level> <level label="xvii"> <text>Provide the advance directive information sheet developed under § 5–615 of this article:</text> <level label="1"> <text>To all enrollees at the time of initial enrollment and in the managed care organization’s enrollee publications;</text> </level> <level label="2"> <text>If the managed care organization maintains a website, on the managed care organization’s website; and</text> </level> <level label="3"> <text>At the request of an enrollee; and</text> </level> </level> <level label="xviii"> <text>If the managed care organization maintains a website, provide a link to the webpage that is accessed through the tab on the State–designated health information exchange website required under § 19–145.1(b)(2)(iv) of this article.</text> </level> </level> <level label="2"> <text>Paragraph (1)(xvii) of this subsection may not be construed to require a managed care organization to:</text> <level label="i"> <text>Assist an enrollee in drafting an electronic advance care planning document;</text> </level> <level label="ii"> <text>Store electronic advance care planning documents; or</text> </level> <level label="iii"> <text>Access advance care planning documents.</text> </level> </level> <level label="3"> <level label="i"> <text>Each managed care organization shall notify each enrollee when the enrollee should obtain an immunization, examination, or other wellness service.</text> </level> <level label="ii"> <text>Each managed care organization shall:</text> <level label="1"> <text>Maintain evidence of compliance with paragraph (1) of this subsection; and</text> </level> <level label="2"> <text>On initial application to provide health care services to enrollees and on an annual basis thereafter, provide to the Department evidence of compliance with paragraph (1) of this subsection including submission of a written plan.</text> </level> </level> <level label="iii"> <text>A managed care organization that does not comply with paragraph (1) of this subsection for at least 90% of its new enrollees:</text> <level label="1"> <text>Within 90 days of their enrollment may not receive more than 80% of its capitation payments;</text> </level> <level label="2"> <text>Within 180 days of their enrollment may not receive more than 70% of its capitation payments; and</text> </level> <level label="3"> <text>Within 270 days of their enrollment may not receive more than 50% of its capitation payments.</text> </level> </level> <level label="iv"> <text>If a managed care organization does not comply with the requirements of paragraph (1) of this subsection, the Department may contract with any community–based health organization that the Department determines is willing and able to perform comprehensive outreach services to enrollees.</text> </level> <level label="v"> <text>In addition to the provisions of subparagraph (iv) of this paragraph, if a managed care organization does not comply with the requirements of paragraph (1) of this subsection or fails to provide evidence of compliance to the Department under subparagraph (ii) of this paragraph, the Department may:</text> <level label="1"> <text>Impose a fine on the managed care organization;</text> </level> <level label="2"> <text>Suspend further enrollment into the managed care organization;</text> </level> <level label="3"> <text>Withhold all or part of the capitation rate from the managed care organization;</text> </level> <level label="4"> <text>Terminate the provider agreement; or</text> </level> <level label="5"> <text>Disqualify the managed care organization from future participation in the program established under subsection (a) of this section.</text> </level> </level> <level label="vi"> <text>The Department shall deposit fines imposed under subparagraph (v)1 of this paragraph in the HealthChoice Performance Incentive Fund established under § 15–103.5 of this subtitle.</text> </level> </level> </level> <level label="j"> <text>The Department shall adopt regulations that ensure that managed care organizations employ appropriate personnel to:</text> <level label="1"> <text>Ensure that individuals with special needs obtain needed services; and</text> </level> <level label="2"> <text>Coordinate those services.</text> </level> </level> <level label="k"> <level label="1"> <text>A managed care organization shall reimburse a hospital emergency facility and provider for:</text> <level label="i"> <text>Health care services that meet the definition of emergency services in § 19–701 of this article;</text> </level> <level label="ii"> <text>Medical screening services rendered to meet the requirements of the federal Emergency Medical Treatment and Active Labor Act;</text> </level> <level label="iii"> <text>Medically necessary services if the managed care organization authorized, referred, or otherwise allowed the enrollee to use the emergency facility and the medically necessary services are related to the condition for which the enrollee was allowed to use the emergency facility; and</text> </level> <level label="iv"> <text>Medically necessary services that relate to the condition presented and that are provided by the provider in the emergency facility to the enrollee if the managed care organization fails to provide 24–hour access to a physician as required by the Department.</text> </level> </level> <level label="2"> <text>A provider may not be required to obtain prior authorization or approval for payment from a managed care organization in order to obtain reimbursement under this subsection.</text> </level> </level> <level label="l"> <text>The Department shall:</text> <level label="1"> <text>Establish and maintain an ombudsman program and a locally accessible enrollee hotline;</text> </level> <level label="2"> <text>Perform focused medical reviews of managed care organizations that include reviews of how the managed care organizations are providing health care services to special populations;</text> </level> <level label="3"> <text>Provide timely feedback to each managed care organization on its compliance with the Department’s quality and access system;</text> </level> <level label="4"> <text>Establish and maintain within the Department a process for handling provider complaints about managed care organizations; and</text> </level> <level label="5"> <text>Adopt regulations relating to appeals by managed care organizations of penalties imposed by the Department, including regulations providing for an appeal to the Office of Administrative Hearings.</text> </level> </level> <level label="m"> <level label="1"> <text>Subject to paragraph (3) of this subsection, the Department shall delegate responsibility for maintaining the ombudsman program for a county to that county’s local health department on the request of the local health department.</text> </level> <level label="2"> <text>A local health department may not subcontract the ombudsman program.</text> </level> <level label="3"> <text>Before the Department delegates responsibility to a local health department to maintain the ombudsman program for a county, a local health department that is also a Medicaid provider must receive the approval of the Secretary and the local governing body.</text> </level> </level> <level label="n"> <text>A managed care organization may not:</text> <level label="1"> <text>Without authorization by the Department, enroll an individual who at the time is a Program recipient; or</text> </level> <level label="2"> <text>Have face–to–face or telephone contact with, or otherwise solicit, an individual who at the time is a Program recipient before the Program recipient enrolls in the managed care organization unless:</text> <level label="i"> <text>Authorized by the Department; or</text> </level> <level label="ii"> <text>The Program recipient initiates contact.</text> </level> </level> </level> <level label="o"> <level label="1"> <text>The Department shall be responsible for enrolling Program recipients into managed care organizations.</text> </level> <level label="2"> <text>The Department may contract with an entity to perform the enrollment function.</text> </level> <level label="3"> <text>The Department or its enrollment contractor shall administer a health risk assessment developed by the Department to ensure that individuals who need special or immediate health care services will receive the services on a timely basis.</text> </level> <level label="4"> <text>The Department or its enrollment contractor:</text> <level label="i"> <text>May administer the health risk assessment only after the Program recipient has chosen a managed care organization; and</text> </level> <level label="ii"> <text>Shall forward the results of the health risk assessment to the managed care organization chosen by the Program recipient within 5 business days.</text> </level> </level> </level> <level label="p"> <text>For a managed care organization with which the Secretary contracts to provide services to Program recipients under this section, the Secretary shall establish a mechanism to initially ensure that each historic provider that meets the Department’s quality standards has the opportunity to continue to serve Program recipients as a subcontractor of at least one managed care organization.</text> </level> <level label="q"> <level label="1"> <text>The Department shall make capitation payments to each managed care organization as provided in this subsection.</text> </level> <level label="2"> <text>In consultation with the Insurance Commissioner, the Secretary shall:</text> <level label="i"> <text>Set capitation payments at a level that is actuarially adjusted to the benefits provided; and</text> </level> <level label="ii"> <text>Actuarially adjust the capitation payments to reflect the relative risk assumed by the managed care organization.</text> </level> </level> <level label="3"> <text>In actuarially adjusting capitation payments under paragraph (2)(ii) of this subsection, the Secretary, in consultation with the Insurance Commissioner, shall take into account, to the extent allowed under federal law, the expenses incurred by the managed care organization applicable to the business of providing care to enrolled individuals.</text> </level> </level> <level label="r"> <level label="1"> <text>School–based clinics and managed care organizations shall collaborate to provide continuity of care to enrollees.</text> </level> <level label="2"> <text>School–based clinics shall be defined by the Department in consultation with the State Department of Education.</text> </level> <level label="3"> <text>Each managed care organization shall require a school–based clinic to provide to the managed care organization information, as specified by the Department, about an encounter with an enrollee of the managed care organization before paying the school–based clinic.</text> </level> <level label="4"> <text>On receipt of information specified by the Department, the managed care organization shall pay, at Medicaid–established rates, school–based clinics for covered services provided to enrollees of the managed care organization.</text> </level> <level label="5"> <text>The Department shall work with managed care organizations and school–based clinics to develop collaboration standards, guidelines, and a process to ensure that the services provided are covered and medically appropriate and that the process provides for timely notification among the parties.</text> </level> <level label="6"> <text>Each managed care organization shall maintain records of all health care services:</text> <level label="i"> <text>Provided to its enrollees by school–based clinics; and</text> </level> <level label="ii"> <text>For which the managed care organization has been billed.</text> </level> </level> </level> <level label="s"> <text>The Department shall establish standards for the timely delivery of services to enrollees.</text> </level> <level label="t"> <level label="1"> <text>The Department shall establish a delivery system for specialty mental health services for enrollees of managed care organizations.</text> </level> <level label="2"> <text>The Behavioral Health Administration shall:</text> <level label="i"> <text>Design and monitor the delivery system;</text> </level> <level label="ii"> <text>Establish performance standards for providers in the delivery system; and</text> </level> <level label="iii"> <text>Establish procedures to ensure appropriate and timely referrals from managed care organizations to the delivery system that include:</text> <level label="1"> <text>Specification of the diagnoses and conditions eligible for referral to the delivery system;</text> </level> <level label="2"> <text>Training and clinical guidance in appropriate use of the delivery system for managed care organization primary care providers;</text> </level> <level label="3"> <text>Preauthorization by the utilization review agent of the delivery system; and</text> </level> <level label="4"> <text>Penalties for a pattern of improper referrals.</text> </level> </level> </level> <level label="3"> <text>The Department shall collaborate with managed care organizations to develop standards and guidelines for the provision of specialty mental health services.</text> </level> <level label="4"> <text>The delivery system shall:</text> <level label="i"> <text>Provide all specialty mental health services needed by enrollees;</text> </level> <level label="ii"> <text>For enrollees who are dually diagnosed, coordinate the provision of substance use disorder treatment services provided by the managed care organizations of the enrollees;</text> </level> <level label="iii"> <text>Consist of a network of qualified mental health professionals from all core disciplines;</text> </level> <level label="iv"> <text>Include linkages with other public service systems; and</text> </level> <level label="v"> <text>Comply with quality assurance, enrollee input, data collection, and other requirements specified by the Department in regulation.</text> </level> </level> <level label="5"> <text>The Department may contract with a managed care organization for delivery of specialty mental health services if the managed care organization meets the performance standards adopted by the Department in regulations.</text> </level> <level label="6"> <text>The provisions of § 15–1005 of the Insurance Article apply to the delivery system for specialty mental health services established under this subsection and administered by an administrative services organization.</text> </level> <level label="7"> <text>The Department and the Behavioral Health Administration shall ensure that the delivery system has an adequate network of providers available to provide substance use disorder treatment for children under the age of 18 years.</text> </level> </level> <level label="u"> <text>The Department shall include a definition of medical necessity in its quality and access standards.</text> </level> <level label="v"> <level label="1"> <text>The Department shall adopt regulations relating to enrollment, disenrollment, and enrollee appeals.</text> </level> <level label="2"> <text>Program recipients shall have the right to choose:</text> <level label="i"> <text>The managed care organization with which they are enrolled; and</text> </level> <level label="ii"> <text>The primary care provider to whom they are assigned within the managed care organization.</text> </level> </level> <level label="3"> <text>If a recipient is disenrolled and reenrolls within 120 days after the recipient’s disenrollment, the Department shall:</text> <level label="i"> <text>Assign the recipient to the managed care organization in which the recipient previously was enrolled; and</text> </level> <level label="ii"> <text>Require the managed care organization to assign the recipient to the primary care provider of record at the time of the recipient’s disenrollment.</text> </level> </level> <level label="4"> <text>Whenever a recipient has to select a new managed care organization because the recipient’s managed care organization has departed from the program established under subsection (a) of this section, the departing managed care organization:</text> <level label="i"> <text>Shall provide a written notice to the recipient 60 days before departing from the program established under subsection (a) of this section;</text> </level> <level label="ii"> <text>Shall include in the notice the name and provider number of the primary care provider assigned to the recipient and the telephone number of the enrollment broker; and</text> </level> <level label="iii"> <text>Within 30 days after departing from the program, shall provide the Department with a list of enrollees and the name of each enrollee’s primary care provider.</text> </level> </level> <level label="5"> <text>On receiving the list provided by the managed care organization, the Department shall provide the list to:</text> <level label="i"> <text>The enrollment broker to assist and provide outreach to recipients in selecting a managed care organization; and</text> </level> <level label="ii"> <text>The remaining managed care organizations for the purpose of linking recipients with a primary care provider in accordance with federal law and regulation.</text> </level> </level> <level label="6"> <text>Subject to subsection (dd)(4) and (5) of this section, an enrollee may disenroll from a managed care organization:</text> <level label="i"> <text>Without cause in the month following the anniversary date of the enrollee’s enrollment; and</text> </level> <level label="ii"> <text>For cause, at any time as determined by the Secretary.</text> </level> </level> </level> <level label="w"> <text>The Department or its subcontractor, to the extent feasible in its marketing or enrollment programs, shall hire individuals receiving assistance under the program of Aid to Families with Dependent Children established under Title IV, Part A of the Social Security Act, or the successor to the program.</text> </level> <level label="x"> <text>The Department shall disenroll an enrollee who is a child in State–supervised care if the child is transferred to an area outside the territory of the managed care organization.</text> </level> <level label="y"> <text>The Secretary shall adopt regulations to carry out this section.</text> </level> <level label="z"> <text>A managed care organization shall provide coverage for hearing loss screenings of newborns provided by a hospital before discharge.</text> </level> <level label="aa"> <level label="1"> <text>The Department shall provide enrollees and health care providers with an accurate directory or other listing of all available providers:</text> <level label="i"> <text>In written form, made available on request; and</text> </level> <level label="ii"> <text>On an Internet database.</text> </level> </level> <level label="2"> <text>The Department shall update the Internet database at least every 30 days.</text> </level> <level label="3"> <text>The written directory shall include a conspicuous reference to the Internet database.</text> </level> </level> <level label="bb"> <text>A managed care organization may not apply a prior authorization requirement for a prescription drug used as postexposure prophylaxis for the prevention of HIV if the prescription drug is prescribed for use in accordance with Centers for Disease Control and Prevention guidelines.</text> </level> <level label="cc"> <text>The Secretary shall adopt regulations for pharmacy benefits managers that contract with managed care organizations that establish requirements for conducting audits of pharmacies or pharmacists that are:</text> <level label="1"> <text>To the extent practicable, substantively similar to the audit provisions under § 15–1629 of the Insurance Article; and</text> </level> <level label="2"> <text>Consistent with federal law.</text> </level> </level> <level label="dd"> <level label="1"> <text>The Department shall establish mechanisms for:</text> <level label="i"> <text>Identifying a Program recipient’s primary care provider at the time of enrollment into a managed care program; and</text> </level> <level label="ii"> <text>Maintaining continuity of care with the primary care provider if:</text> <level label="1"> <text>The provider has a contract with a managed care organization or a contracted medical group of a managed care organization to provide primary care services; and</text> </level> <level label="2"> <text>The recipient desires to continue care with the provider.</text> </level> </level> </level> <level label="2"> <text>If a Program recipient enrolls in a managed care organization and requests assignment to a particular primary care provider who has a contract with the managed care organization or a contracted group of the managed care organization, the managed care organization shall assign the recipient to the primary care provider.</text> </level> <level label="3"> <level label="i"> <text>A Program recipient may request a change of primary care providers within the same managed care organization at any time.</text> </level> <level label="ii"> <text>If the primary care provider has a contract with the managed care organization or a contracted group of the managed care organization, the managed care organization shall honor a request made under subparagraph (i) of this paragraph.</text> </level> </level> <level label="4"> <text>In accordance with the federal Health Care Financing Administration’s guidelines, a Program recipient may elect to disenroll from a managed care organization if the managed care organization terminates its contract with the Department.</text> </level> <level label="5"> <text>A Program recipient may disenroll from a managed care organization to maintain continuity of care with a primary care provider if:</text> <level label="i"> <text>The contract between the primary care provider and the managed care organization or contracted group of the managed care organization terminates because:</text> <level label="1"> <text>The managed care organization or contracted group of the managed care organization terminates the provider’s contract for a reason other than quality of care or the provider’s failure to comply with contractual requirements related to quality assurance activities;</text> </level> <level label="2"> <level label="A"> <text>The managed care organization or contracted group of the managed care organization reduces the primary care provider’s capitated or applicable fee for services rates;</text> </level> </level> <level label="B"> <text>The reduction in rates is greater than the actual change in rates or capitation paid to the managed care organization by the Department; and</text> </level> <level label="C"> <text>The provider and the managed care organization or contracted group of the managed care organization are unable to negotiate a mutually acceptable rate; or</text> </level> <level label="3"> <text>The provider contract between the provider and the managed care organization is terminated because the managed care organization is acquired by another entity; and</text> </level> </level> <level label="ii"> <level label="1"> <text>The Program recipient desires to continue to receive care from the primary care provider;</text> </level> <level label="2"> <text>The provider contracts with at least one other managed care organization or contracted group of a managed care organization; and</text> </level> <level label="3"> <text>The enrollee notifies the Department or the Department’s designee of the enrollee’s intention within 90 days after the contract termination.</text> </level> </level> </level> <level label="6"> <text>The Department shall provide timely notification to the affected managed care organization of an enrollee’s intention to disenroll under the provisions of paragraph (5) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-103.2" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “Committee” means the Maryland Medicaid Advisory Committee.</text> </level> <level label="b"> <text>The Department shall establish the Maryland Medicaid Advisory Committee.</text> </level> <level label="c"> <level label="1"> <text>The Committee shall be composed of not more than 25 members.</text> </level> <level label="2"> <text>The majority of the members of the Committee shall be enrollees or enrollee advocates.</text> </level> <level label="3"> <text>At least five members of the Committee shall be enrollees representative of the entire Medicaid population.</text> </level> <level label="4"> <text>The Committee members shall include:</text> <level label="i"> <text>At least five current or former enrollees or the parents or guardians of current or former enrollees;</text> </level> <level label="ii"> <text>Providers who are familiar with the medical needs of low–income population groups, including board–certified physicians;</text> </level> <level label="iii"> <text>Hospital representatives;</text> </level> <level label="iv"> <text>At least five but not more than 10 advocates for the Medicaid population, including representatives of special needs populations, such as:</text> <level label="1"> <text>Children with special needs;</text> </level> <level label="2"> <text>Individuals with physical disabilities;</text> </level> <level label="3"> <text>Individuals with developmental disabilities;</text> </level> <level label="4"> <text>Individuals with mental illness;</text> </level> <level label="5"> <text>Individuals with brain injuries;</text> </level> <level label="6"> <text>Medicaid and Medicare dual eligibles;</text> </level> <level label="7"> <text>Individuals who are homeless or have experienced homelessness;</text> </level> <level label="8"> <text>Individuals enrolled in home– and community–based services waivers;</text> </level> <level label="9"> <text>Elderly individuals;</text> </level> <level label="10"> <text>Low–income individuals and individuals receiving benefits through the Temporary Assistance for Needy Families Program; and</text> </level> <level label="11"> <text>Individuals receiving substance use treatment services;</text> </level> </level> <level label="v"> <text>Two members of the Senate Finance Committee, appointed by the President of the Senate; and</text> </level> <level label="vi"> <text>Three members of the House of Delegates, appointed by the Speaker of the House.</text> </level> </level> <level label="5"> <text>A designee of each of the following shall serve as an ex officio member of the Committee:</text> <level label="i"> <text>The Secretary of Human Services;</text> </level> <level label="ii"> <text>The Executive Director of the Maryland Health Care Commission; and</text> </level> <level label="iii"> <text>The Maryland Association of County Health Officers.</text> </level> </level> <level label="6"> <text>The Secretary shall appoint nonvoting members from managed care organizations who may participate in Committee meetings, unless the Committee meets in closed session as provided in § 3–305 of the General Provisions Article.</text> </level> <level label="7"> <level label="i"> <text>Except as specified in paragraphs (4)(v) and (vi) and (5) of this subsection, the members of the Committee shall be appointed by the Secretary and serve for a 4–year term.</text> </level> <level label="ii"> <text>In making appointments to the Committee, the Secretary shall provide for continuity and rotation.</text> </level> <level label="iii"> <text>In appointing consumer members to the Committee, the Secretary shall seek recommendations from:</text> <level label="1"> <text>The State Protection and Advocacy System Organization;</text> </level> <level label="2"> <text>The Statewide Independent Living Council;</text> </level> <level label="3"> <text>The Developmental Disabilities Council;</text> </level> <level label="4"> <text>The Department of Disabilities;</text> </level> <level label="5"> <text>The Department of Aging;</text> </level> <level label="6"> <text>Consumer advocacy organizations; and</text> </level> <level label="7"> <text>The public.</text> </level> </level> </level> </level> <level label="d"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, a member of the Committee:</text> <level label="i"> <text>May not receive compensation; but</text> </level> <level label="ii"> <text>Is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.</text> </level> </level> <level label="2"> <text>A member of the Committee who is an enrollee is entitled to reimbursement for:</text> <level label="i"> <text>Expenses for personal and dependent care incurred during the meeting and during travel time to and from the meeting;</text> </level> <level label="ii"> <text>Expenses for cognitive supports related to the meeting; and</text> </level> <level label="iii"> <text>Appropriate transportation to and from the meeting.</text> </level> </level> <level label="3"> <text>On request, the Department shall provide for a dedicated Department staff person:</text> <level label="i"> <text>To review meeting materials with enrollee members in advance of a meeting by telephone or in person; and</text> </level> <level label="ii"> <text>To provide referrals to advocacy organizations.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>The Secretary shall appoint the chair of the Committee.</text> </level> <level label="2"> <text>The Department shall provide staff for the Committee.</text> </level> <level label="3"> <text>The Committee shall determine the times and places of its meetings.</text> </level> <level label="4"> <level label="i"> <text>The chair of the Committee and the staff for the Committee shall provide the agenda, minutes, and any written materials to be presented or discussed at a meeting to the members of the Committee at least 5 days before the meeting.</text> </level> <level label="ii"> <text>The agenda, minutes, and written materials shall be provided to members of the Committee in a manner and format that reasonably accommodates the specific needs of the member.</text> </level> </level> </level> <level label="f"> <text>In addition to any duties imposed by federal law and regulation, the Committee shall:</text> <level label="1"> <text>Advise the Secretary on the implementation, operation, and evaluation of managed care programs under this section;</text> </level> <level label="2"> <text>Review and make recommendations on the regulations developed to implement managed care programs under § 15–103.1 of this subtitle;</text> </level> <level label="3"> <text>Review and make recommendations on the standards used in contracts between the Department and managed care organizations;</text> </level> <level label="4"> <text>Review and make recommendations on the Department’s oversight of quality assurance standards;</text> </level> <level label="5"> <text>Review data collected by the Department from managed care organizations participating in the Program and data collected by the Maryland Health Care Commission;</text> </level> <level label="6"> <text>Promote the dissemination of managed care organization performance information, including loss ratios, to enrollees in a manner that facilitates quality comparisons and uses layman’s language;</text> </level> <level label="7"> <text>Assist the Department in evaluating the enrollment process; and</text> </level> <level label="8"> <text>Review reports of the ombudsmen.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-103.3" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Program shall use its leverage as a high volume purchaser to promote the cost effectiveness of Maryland’s health care system.</text> </section> <section article="ghg" article_name="Health - General" number="15-103.4" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Department shall issue a request for proposals for the administration of dental services for Program recipients for the purpose of comparing and evaluating the performance and cost of dental services provided by a managed care organization and the performance and cost of dental services provided by a dental managed care organization that is separate from a managed care organization.</text> </level> <level label="b"> <text>The Department shall provide access to Program recipients for dental services to increase utilization of dental services in accordance with utilization targets that the Department by regulation establishes in an oral health care plan.</text> </level> <level label="c"> <text>The access required under subsection (b) of this section may be through a managed care organization or a dental managed care organization that is separate from a managed care organization.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-103.5" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>There is a HealthChoice Performance Incentive Fund established in the Department.</text> </level> <level label="b"> <level label="1"> <text>The Department shall pay all fines collected under § 15–103.1(i)(3)(v) of this subtitle and penalties collected under § 15–103.9(e)(2)(iv) of this subtitle to the Comptroller of the State.</text> </level> <level label="2"> <text>The Comptroller shall distribute the fines to the Fund.</text> </level> </level> <level label="c"> <level label="1"> <text>The Fund shall be used exclusively for the provider reimbursement budget under the HealthChoice Program, including providing financial incentives designed to improve the quality of care to managed care organizations that exceed performance targets.</text> </level> <level label="2"> <text>The Fund is a continuing nonlapsing fund not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="3"> <text>Except as provided in paragraph (4) of this subsection, any unspent portions of the Fund may not be transferred or revert to the General Fund of the State, but shall remain in the Fund to be used for the purposes specified in this section.</text> </level> <level label="4"> <text>At the end of each fiscal year, any amount in excess of $5 million shall revert to the General Fund.</text> </level> </level> <level label="d"> <level label="1"> <text>The Secretary or the Secretary’s designee shall administer the Fund.</text> </level> <level label="2"> <text>The Secretary shall adopt regulations to carry out the provisions of this section, including the distribution of money from the Fund to managed care organizations.</text> </level> </level> <level label="e"> <text>The Legislative Auditor shall audit the accounts and transactions of the Fund as provided in § 2–1220 of the State Government Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-103.6" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>A managed care organization may deem a health care provider credentialed for a period of not more than 6 months from the date of receipt of a completed application if:</text> <level label="1"> <text>The health care provider:</text> <level label="i"> <text>Has been credentialed by another entity in the State that is required to credential health care providers; and</text> </level> <level label="ii"> <text>Has submitted an application to participate in the managed care organization’s provider panel; and</text> </level> </level> <level label="2"> <text>The managed care organization verifies that the health care provider was credentialed and remains in good standing with at least one entity that credentialed the health care provider.</text> </level> </level> <level label="b"> <text>An entity that has credentialed a health care provider may not refuse a request by a managed care organization to verify that the health care provider is credentialed and in good standing.</text> </level> <level label="c"> <text>Nothing in this section may be construed to relieve the managed care organization from fully credentialing its health care providers.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-103.7" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>For the calendar year prior to the report date under subsection (b) of this section, the Department shall review the rates paid to providers under the federal Medicare fee schedule and compare the rates under the Medicare fee schedule to the fee–for–service rates paid to similar providers for the same services under the Maryland Medical Assistance Program and the rates paid to managed care organization providers for the same services under the Maryland Medical Assistance Program.</text> </level> <level label="b"> <text>On or before January 1, 2010, and each January 1 thereafter, the Department shall report, in accordance with § 2–1257 of the State Government Article, to the Senate Finance Committee and the House Health and Government Operations Committee on:</text> <level label="1"> <text>The review and comparison under subsection (a) of this section;</text> </level> <level label="2"> <text>Whether the fee–for–service rates and managed care organization provider rates will exceed the rates paid under the Medicare fee schedule for the period covered by the review required under subsection (a) of this section;</text> </level> <level label="3"> <text>An analysis of the fee–for–service reimbursement rates paid in other states and how those rates compare with those in the State;</text> </level> <level label="4"> <text>A schedule for bringing the State’s fee–for–service reimbursement rates to a level that assures that all health care providers are reimbursed adequately to provide access to care; and</text> </level> <level label="5"> <text>An analysis of the estimated costs of implementing the schedule and any proposed changes to the fee–for–service reimbursement rates for the Maryland Medical Assistance Program and the Maryland Children’s Health Program.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-103.8" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>Subject to paragraph (2) of this subsection, on or before June 30, 2017, the Department shall adopt regulations necessary to ensure that the Program is in compliance with the federal Mental Health Parity and Addiction Equity Act and the federal Patient Protection and Affordable Care Act.</text> </level> <level label="2"> <text>Except as provided in § 15–103.10 of this subtitle, the Department is not required to adopt regulations under paragraph (1) of this subsection for any change that may be made through a process other than the regulatory process.</text> </level> </level> <level label="b"> <text>The regulations adopted under subsection (a) of this section shall include standards regarding treatment limitations for specialty mental health and substance use disorder services that comply with the federal Mental Health Parity and Addiction Equity Act and the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010, and relate to:</text> <level label="1"> <text>The scope of benefits for:</text> <level label="i"> <text>Telehealth services; and</text> </level> <level label="ii"> <text>Residential treatment programs that are not institutions for mental disease;</text> </level> </level> <level label="2"> <text>Service notification and authorization requirements;</text> </level> <level label="3"> <text>Licensed specialty mental health or substance use disorder program billing for:</text> <level label="i"> <text>Services provided by physicians, advanced practice nurses, and physician assistants;</text> </level> <level label="ii"> <text>Services provided by a licensed specialty mental health or substance use disorder program at a location that is not the primary location at which the program is licensed; and</text> </level> <level label="iii"> <text>Separate levels of service provided within a single day or week; and</text> </level> </level> <level label="4"> <text>Reimbursement rates.</text> </level> </level> <level label="c"> <text>The treatment limitations for specialty mental health and substance use disorder services comply with the federal Mental Health Parity and Addiction Equity Act and the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010, if the operable processes, strategies, evidentiary standards, or other factors used in applying a treatment limitation to specialty mental health or substance use disorder services, as written and applied, are comparable to and no more restrictive than, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the treatment limitation to medical and surgical services.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-103.9" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “Program” means the program established by the Department under subsection (b) of this section.</text> </level> <level label="b"> <level label="1"> <text>The Department shall establish a value–based purchasing program that awards financial incentives to and assesses penalties on managed care organizations based on the organization’s performance on health measures established by the Department.</text> </level> <level label="2"> <text>The Department shall, in accordance with this section, establish criteria to implement the Program, including the establishment of performance targets, award of incentives, and collection of penalties.</text> </level> </level> <level label="c"> <text>Not more than 1% of the amount of capitated payments received by a managed care organization each year shall be subject to the collection of penalties under the Program.</text> </level> <level label="d"> <text>For each measurement year, beginning January 1, 2021, the Department may not in any calendar year pay a total amount of incentives to managed care organizations under the Program in an amount that exceeds:</text> <level label="1"> <text>The total amount of penalties the Department collects from managed care organizations under the Program; and</text> </level> <level label="2"> <text>Any additional funds allocated by the Department to support the Program.</text> </level> </level> <level label="e"> <level label="1"> <text>For each measurement year, beginning January 1, 2021, the Department shall base the initial distribution of funding awarded under the Program to a managed care organization in each calendar year on the number of performance targets that the managed care organization meets or exceeds.</text> </level> <level label="2"> <text>For each measurement year, beginning January 1, 2021, if the total amount of penalties that the Department collects under the Program exceeds the total amount of incentive funding awarded in the initial distribution of funds in a calendar year under the Program, the remaining funds shall be allocated as follows:</text> <level label="i"> <text>40% to managed care organizations that have met or exceeded more performance targets than the managed care organization has not met;</text> </level> <level label="ii"> <text>25% to managed care organizations that the Department determines have demonstrated performance improvement in the measurement year, if the managed care organizations use the funding to target performance improvement in areas identified by the Department;</text> </level> <level label="iii"> <text>25% for health improvement programs under the Maryland Medicaid Managed Care Program, with the funding used to fund enhancements in:</text> <level label="1"> <text>Areas where the Maryland Medicaid Managed Care Program as a whole underperforms as compared to equivalent programs in other states; or</text> </level> <level label="2"> <text>Areas determined by the Department to be a State health priority;</text> </level> </level> <level label="iv"> <text>Except as provided in item (v) of this paragraph, 10% to establish a reserve in the HealthChoice Performance Incentive Fund to be used in any calendar year in which the amount of penalties the Department collects under the Program are insufficient to pay incentives earned by managed care organizations; and</text> </level> <level label="v"> <text>If the Department may not allocate funds, in whole or in part, in accordance with item (iv) of this paragraph because of the limitation in paragraph (3) of this subsection, the Department shall equally allocate the remaining funds for use under items (i), (ii), and (iii) of this paragraph.</text> </level> </level> <level label="3"> <text>The Department may not allocate funds under paragraph (2)(iv) of this subsection in a manner that causes the balance in the HealthChoice Performance Incentive Fund to exceed $5 million.</text> </level> </level> <level label="f"> <text>Subject to the provisions of this section, the Department may modify the Program if the Department:</text> <level label="1"> <text>Adopts by regulation any changes to the core set of performance measures and the methodology for penalties, rewards, disincentives, or incentives under subsection (e)(1) and (2)(i) of this section before the calendar year for which the managed care organizations will be held accountable for the standard compliance with the performance measures; and</text> </level> <level label="2"> <text>Notifies each managed care organization of the core set of performance measures and targets under subsection (e)(1) and (2)(i) of this section at least 3 months before the calendar year for which the managed care organization will be held accountable to the standard for compliance with the performance measures.</text> </level> </level> <level label="g"> <text>Any penalty or capitation adjustment imposed under this section on a managed care organization may not be accomplished or implemented by withholding a capitation payment.</text> </level> <level label="h"> <text>The Department shall adopt regulations to carry out this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-103.10" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>Notwithstanding any other provision of law, the Department may not limit or restrict a Program recipient’s admission for inpatient care at a special psychiatric hospital or an acute general care hospital with separately identified inpatient psychiatric service unless the Department:</text> <level label="1"> <text>Bases the limit or restriction on the medical necessity of the admission; and</text> </level> <level label="2"> <text>Establishes the limit or restriction through regulation.</text> </level> </level> <level label="b"> <text>On or before July 1 each year, beginning in 2024, the Department shall report to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, on, for the immediately preceding fiscal year:</text> <level label="1"> <text>The average length of stay for Program recipients for Serious Mental Illness Institute of Mental Disease services and for Substance Use Disorder Institute of Mental Disease services as reported to the Centers for Medicare and Medicaid Services;</text> </level> <level label="2"> <text>Any corrective action plans and any limits on days of stay required by the Centers for Medicare and Medicaid Services;</text> </level> <level label="3"> <text>Any federal funding withheld and any additional State funding required due to subsection (a) of this section;</text> </level> <level label="4"> <text>Data on the effect of subsection (a) of this section on the length of emergency department stays among Program recipients; and</text> </level> <level label="5"> <text>Data on whether Program recipients receiving Institute of Mental Disease services were transferred to another facility and the type of facility to which they were transferred.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-103.11" future_version_removed="true" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Ex parte redetermination” means a process by which the Department determines a Program recipient’s eligibility to continue to receive services using existing data, without requiring the Program recipient to submit additional information.</text> </level> <level label="3"> <text>“Home– and community–based services” means services authorized under a Medicaid State Plan option or waiver under § 1115 or § 1915(c), (i), or (k) of the federal Social Security Act.</text> </level> <level label="4"> <text>“Procedural disenrollment” means the termination of a Program recipient’s eligibility to receive services based on reasons related to the renewal process and not on a determination of ineligibility.</text> </level> </level> <level label="b"> <text>The Department shall comply with the requirements of 42 C.F.R. § 435.912 related to the timely determination and redetermination of Program eligibility, including processing an application:</text> <level label="1"> <text>If a determination of disability is not required, within 45 days after the receipt of the application; and</text> </level> <level label="2"> <text>If a determination of disability is required, within 90 days after the receipt of the application.</text> </level> </level> <level label="c"> <text>The Department shall conduct ex parte redeterminations and use all procedures authorized under 42 C.F.R. § 435.916 to prevent procedural disenrollment of individuals receiving home– and community–based services.</text> </level> <level label="d"> <text>In accordance with 42 C.F.R. § 435.905 and subject to subsection (e) of this section, the Department shall provide, in electronic and paper formats, and orally as an accommodation, the following information to all applicants and other individuals on request:</text> <level label="1"> <text>Requirements for Program eligibility;</text> </level> <level label="2"> <text>Available Program services; and</text> </level> <level label="3"> <text>The rights and responsibilities of applicants and Program recipients.</text> </level> </level> <level label="e"> <level label="1"> <text>The Department shall provide the information required under subsection (d) of this section in plain language and in a manner that is timely and accessible to individuals who are:</text> <level label="i"> <text>Limited English proficient through the provision of language services, including oral interpretation and written translations, at no cost to the individual; or</text> </level> <level label="ii"> <text>Living with disabilities through the provision of auxiliary aids and services at no cost to the individual in accordance with the federal Americans with Disabilities Act and § 504 of the federal Rehabilitation Act of 1973.</text> </level> </level> <level label="2"> <text>The Department shall provide taglines in non–English languages to inform individuals of:</text> <level label="i"> <text>The availability of the accessible information and language services under this section; and</text> </level> <level label="ii"> <text>How to access the information and services.</text> </level> </level> </level> <level label="f"> <level label="1"> <text>If a Program recipient is procedurally disenrolled from home– and community–based services due to a failure by the Department to redetermine eligibility in a timely manner after the recipient has timely returned information required under 42 C.F.R. § 435.916(b)(2)(i)(B) and 42 C.F.R. § 435.952(c), the Department shall reinstate the Program recipient’s eligibility and the provision of home– and community–based services and authorize enrollment retroactively to the date of disenrollment pending the Department’s completion of the redetermination process.</text> </level> <level label="2"> <text>This subsection may not be construed to limit the Department’s authority or diminish the Department’s responsibility to reinstate the eligibility of and the provision of home– and community–based services to a Program recipient who has been disenrolled for a reason other than a failure by the Department to redetermine eligibility in a timely manner.</text> </level> </level> <level label="g"> <text>Subject to federal approval, the Department shall reserve capacity in home– and community–based services waivers for services needed by Program recipients with developmental disabilities who:</text> <level label="1"> <text>Were disenrolled from the Maryland Medicaid Home and Community–Based Services waiver program on or after January 1, 2024;</text> </level> <level label="2"> <text>Have had Program eligibility reinstated; and</text> </level> <level label="3"> <text>Have requested the reinstatement of waiver services.</text> </level> </level> <level label="h"> <level label="1"> <text>The Department may not procedurally disenroll an individual from the Program or home– and community–based services solely based on missing documentation, a missing signature, or incomplete information unless the Department has:</text> <level label="i"> <text>Exhausted all ex parte verification processes required under 42 C.F.R. § 435.916;</text> </level> <level label="ii"> <text>Provided a clear, specific, and accessible written notice identifying the exact information required; and</text> </level> <level label="iii"> <text>Provided the Program recipient with a reasonable opportunity to supply the information.</text> </level> </level> <level label="2"> <text>If the Department violates paragraph (1) of this subsection, a Program recipient’s home– and community–based services shall continue without interruption.</text> </level> </level> <level label="i"> <text>If the Department disenrolls a Program recipient in violation of this section, the Department shall:</text> <level label="1"> <text>Automatically reinstate Program and home– and community–based services retroactive to the date of disenrollment; and</text> </level> <level label="2"> <text>Treat the Program recipient as continuously enrolled.</text> </level> </level> <level label="j"> <level label="1"> <text>On or before January 1, 2027, and quarterly thereafter, the Department shall:</text> <level label="i"> <text>Submit to the General Assembly, in accordance with § 2–1257 of the State Government Article, a report regarding Program recipients who receive home– and community–based services; and</text> </level> <level label="ii"> <text>Post each report submitted under item (i) of this paragraph on the Department’s website.</text> </level> </level> <level label="2"> <text>The reports required under paragraph (1) of this subsection shall include:</text> <level label="i"> <text>The total number of Program recipients for whom a redetermination of eligibility was initiated;</text> </level> <level label="ii"> <text>The total number of Program recipients for whom Program coverage is renewed;</text> </level> <level label="iii"> <text>Of the Program recipients whose eligibility is renewed, the total number whose coverage was renewed based on an ex parte redetermination;</text> </level> <level label="iv"> <text>The total number of Program recipients whose eligibility was reinstated in accordance with subsection (f) of this section;</text> </level> <level label="v"> <text>The total number of Program recipients whose eligibility was terminated;</text> </level> <level label="vi"> <text>The total number of Program recipients whose eligibility was terminated for procedural reasons;</text> </level> <level label="vii"> <text>The total number of Program recipients whose eligibility was terminated due to a failure by the Department to redetermine eligibility in a timely manner; and</text> </level> <level label="viii"> <text>The mean and median processing times for redeterminations of eligibility.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-104" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Secretary may contract with the Department of Human Services to provide medical services to those individuals for whom:</text> <level label="1"> <text>Funds are appropriated to the Department of Human Services; and</text> </level> <level label="2"> <text>The Department of Human Services is responsible under the appropriation.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-105" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “dual eligibility” means simultaneous eligibility for health insurance coverage under both the Program and Medicare and for which the Department may obtain federal matching funds.</text> </level> <level label="b"> <text>The Department shall adopt rules and regulations for the reimbursement of providers under the Program. However, except for an invoice that must be submitted to a Medicare intermediary or Medicare carrier for an individual with dual eligibility, payment may not be made for an invoice that is received more than 1 year after the dates of the services given.</text> </level> <level label="c"> <text>A provider who fails to submit an invoice within the required time may not recover the amount later from the Program recipient.</text> </level> <level label="d"> <level label="1"> <text>The Department shall adopt regulations for the reimbursement of specialty outpatient treatment and diagnostic services rendered to Program recipients at a freestanding clinic owned and operated by a hospital that is under a capitation agreement approved by the Health Services Cost Review Commission.</text> </level> <level label="2"> <level label="i"> <text>Except as provided in subparagraph (ii) of this paragraph, the reimbursement rate under paragraph (1) of this subsection shall be set according to Medicare standards and principles for retrospective cost reimbursement as described in 42 C.F.R. Part 413 or on the basis of charges, whichever is less.</text> </level> <level label="ii"> <text>The reimbursement rate for hospital outpatient oncology, diagnostic, and rehabilitative services that the hospital transferred to an off–site facility prior to January 1, 1999, shall be set according to the rates approved by the Health Services Cost Review Commission if:</text> <level label="1"> <text>The transfer of services was due to zoning restrictions at the hospital campus;</text> </level> <level label="2"> <text>The off–site facility is surveyed as part of the hospital for purposes of accreditation by the Joint Commission; and</text> </level> <level label="3"> <text>The hospital notifies the Health Services Cost Review Commission in writing by June 1, 2013, that the hospital would like the services provided at the off–site facility to be subject to Title 19, Subtitle 2 of this article.</text> </level> </level> </level> </level> <level label="e"> <level label="1"> <text>In this subsection, “provider” means a community–based program or an individual health care practitioner providing outpatient mental health treatment.</text> </level> <level label="2"> <text>For an individual with dual eligibility, the Program shall reimburse a provider the entire amount of the Program fee for outpatient mental health treatment, including any amount ordinarily withheld as a psychiatric exclusion and any copayment not covered under Medicare.</text> </level> </level> <level label="f"> <text>This section has no effect if its operation would cause this State to lose any federal funds.</text> </level> <level label="g"> <text>The Program shall pay the rates set by the Health Services Cost Review Commission for hospital services, as defined in § 19–201 of this article, provided at:</text> <level label="1"> <text>A freestanding medical facility pilot project authorized under § 19–3A–07 of this article prior to January 1, 2008; and</text> </level> <level label="2"> <text>A freestanding medical facility issued a certificate of need by the Maryland Health Care Commission after July 1, 2015.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-105.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>This section does not apply to a person providing pharmacy benefit manager services.</text> </level> <level label="b"> <text>If a pharmacy is required to submit a request for payment electronically to the Department under § 15-105(b) of this subtitle, then the pharmacy may choose to be reimbursed electronically, and in that event, the Department shall reimburse the pharmacy electronically under the Program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-105.2" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Program shall reimburse health care providers in accordance with the requirements of Title 19, Subtitle 1, Part IV of this article.</text> </section> <section article="ghg" article_name="Health - General" number="15-106" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In cooperation with the professional organizations whose members provide health care under the Program, the Secretary shall establish a system of review for all health care that is provided.</text> </level> <level label="2"> <text>The review shall include a study of the quality of care and the proper use of the services by the Program recipient or the provider.</text> </level> </level> <level label="b"> <text>A member of an appointed committee of any of these professional organizations or an appointed member of a committee of a medical staff of a licensed hospital shall have the immunity from liability described under § 5-628 of the Courts and Judicial Proceedings Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-107" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Department may require facilities that participate in the Program to submit cost reports, as defined by the Department, within the time set by the Department.</text> </level> <level label="b"> <text>If a report is not submitted within that time, the Department shall withhold from the facility up to 10 percent of current interim payments for the calendar month in which the report is due and any later calendar months until the report is submitted.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-107.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>Beginning in 2026, the Department shall conduct the in–State cost–of–dispensing survey at least once every 3 years.</text> </level> <level label="b"> <text>On or before December 1 each year in which the survey required under this section is conducted, the Department shall report the results of the survey to the General Assembly, in accordance with § 2–1257 of the State Government Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-108" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “board” means an appeal board established under this section.</text> </level> <level label="b"> <level label="1"> <text>The Secretary may:</text> <level label="i"> <text>Establish one or more boards for purposes of this section; and</text> </level> <level label="ii"> <text>Designate the jurisdiction of a board.</text> </level> </level> <level label="2"> <text>A board shall consist of 3 members.</text> </level> <level label="3"> <text>Of the 3 board members:</text> <level label="i"> <text>2 shall be appointed by the Secretary; and</text> </level> <level label="ii"> <text>1 shall be chosen by the appointed members.</text> </level> </level> <level label="4"> <text>Of the 2 appointed members of a board:</text> <level label="i"> <text>1 shall be a representative of the industry affected who is an individual knowledgeable in Medicare and Medicaid reimbursement principles; and</text> </level> <level label="ii"> <text>1 shall be an individual who is employed by this State and knowledgeable in Medicare and Medicaid reimbursement principles and who does not participate directly in the field verifications.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>If the Department or an agent of the Department does a field verification of the costs and allowable charges of a facility that participates in the Program, the Department or agent shall notify the facility of the results of the field verification.</text> </level> <level label="2"> <text>Within 60 days after the facility receives the notification required under paragraph (1) of this subsection, the Department shall pay the facility the amount the Department has determined is due the facility by the Department regardless of whether or not the facility files an appeal.</text> </level> </level> <level label="d"> <level label="1"> <text>A facility may appeal the results of a field verification by filing written notice with the appropriate board within 30 days after the facility receives the notice from the Department or its agent.</text> </level> <level label="2"> <level label="i"> <text>Within 30 days after the filing of an appeal to the board by a facility that the Department has determined owes money to the State, the Department shall recalculate the amount that is due to the State based on the field verification, exclusive of the amount in controversy which is subject to the appeal, and shall notify the facility of that amount.</text> </level> <level label="ii"> <text>Subject to the provisions of subparagraphs (iii) and (iv) of this paragraph, payment for the amount due the State, if any, after the recalculation shall be made within 60 days after the facility receives notification of the recalculation.</text> </level> <level label="iii"> <text>If a facility requests a longer payment schedule within 60 days after the facility receives notification of the recalculation, the Department may establish, after consultation with the facility, a longer payment schedule.</text> </level> <level label="iv"> <text>The Department shall establish a longer payment schedule if, in the Department’s reasonable judgment, failure to grant a longer payment schedule would:</text> <level label="1"> <text>Result in financial hardship to the facility; or</text> </level> <level label="2"> <text>Have an adverse effect on the quality of patient care furnished by the facility.</text> </level> </level> </level> <level label="3"> <level label="i"> <text>If a facility files an appeal, the portion of the amount in controversy that is actually paid shall be subject to an award of interest that is:</text> <level label="1"> <text>Calculated from the date the appeal was filed through the date of payment; and</text> </level> <level label="2"> <text>Determined in accordance with a rate of interest established by regulation.</text> </level> </level> <level label="ii"> <text>Interest paid by a facility under subparagraph (i) of this paragraph is not an allowable cost.</text> </level> <level label="iii"> <text>Interest paid to a facility under subparagraph (i) of this paragraph is not subject to any offset or other reduction against otherwise allowable costs.</text> </level> </level> <level label="4"> <text>If a facility other than a hospital, or if the Department is aggrieved by a final decision of the board under this section, the facility or the Department shall place any money due from the facility or from the Department in an interest bearing escrow account. The money shall remain in escrow until a final decision has been rendered.</text> </level> <level label="5"> <text>Upon a final determination of the dispute, the appropriate person administering the escrow account shall distribute the money in that account, including any interest accrued, in conformity with the final determination.</text> </level> </level> <level label="e"> <level label="1"> <text>After the Department receives the findings of a board, the Department shall determine the amount that is due either to this State or to the facility and notify the facility of that amount.</text> </level> <level label="2"> <text>If the facility has accepted the determination made under paragraph (1) of this subsection, within 60 days after the facility receives the notification under paragraph (1) of this subsection the Department shall pay the amount the Department has determined is due the facility, if any.</text> </level> <level label="3"> <text>Subject to the provisions of paragraphs (4) and (5) of this subsection, within 60 days after the facility receives notification, the facility shall pay the amount due the Department, if any.</text> </level> <level label="4"> <text>If a facility requests a longer payment schedule within 30 days after the facility receives notification of the amount due the Department, the Department may establish, after consultation with the facility, a longer payment schedule.</text> </level> <level label="5"> <text>The Department shall establish a longer payment schedule if, in the Department’s reasonable judgment, failure to grant a longer payment schedule would:</text> <level label="i"> <text>Result in financial hardship to the facility; or</text> </level> <level label="ii"> <text>Have an adverse effect on the quality of patient care furnished by the facility.</text> </level> </level> </level> <level label="f"> <level label="1"> <text>The Department or any facility aggrieved by a reimbursement decision of the board under this section may take a direct judicial appeal.</text> </level> <level label="2"> <text>The appeal shall be made as provided for judicial review of final decisions in the Administrative Procedure Act.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-109" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>An individual is not ineligible under the Program solely because Social Security benefits received by the individual are increased, unless:</text> <level label="1"> <text>The individual is considered ineligible because of the increase under applicable rules or regulations of the United States Department of Health and Human Services; and</text> </level> <level label="2"> <text>As to that individual, federal matching funds for the State Program are not available.</text> </level> </level> <level label="b"> <text>Except as provided in § 15–103(b)(2) of this subtitle, to determine eligibility under the Program, the Department annually shall set the allowable yearly income levels in amounts at least equal to the following:</text> <level label="1"> <text>Family of 1 – $2,500.</text> </level> <level label="2"> <text>Family of 2 – $3,000.</text> </level> <level label="3"> <text>Family of 3 – $3,500.</text> </level> <level label="4"> <text>Family of 4 – $4,000.</text> </level> <level label="5"> <text>Family of 5 or more – $4,500 plus an increase of $500 for each family member in excess of 5.</text> </level> </level> <level label="c"> <text>This section is effective only to the extent that its provisions do not conflict with federal requirements for the administration of the Program in this State.</text> </level> <level label="d"> <text>As a condition of eligibility for medical assistance, a recipient is deemed to have assigned to the Secretary of Health or the Secretary’s designee any rights to payment for medical care services from any third party who has the legal liability to make payments for those services, to the extent of any payments made by the Department on behalf of the recipient.</text> </level> <level label="e"> <level label="1"> <text>Each resident of a nursing home who is a recipient of medical assistance shall receive a personal needs allowance.</text> </level> <level label="2"> <text>After a determination of income eligibility is made for a nursing home resident under the Program, the personal needs allowance shall be deducted from the total income of the resident.</text> </level> <level label="3"> <text>The personal needs allowance for each resident of a nursing home who is a recipient of medical assistance shall be:</text> <level label="i"> <text>If on or before June 30, 2002, the federal Centers for Medicare and Medicaid Services approve the Department’s application for an amendment to the State’s existing § 1115 demonstration waiver necessary to implement the Maryland Pharmacy Discount Program established under § 15–124.1 of this subtitle:</text> <level label="1"> <text>Beginning April 1, 2003, $50 per month;</text> </level> <level label="2"> <text>Beginning July 1, 2004, $60 per month; and</text> </level> <level label="3"> <text>Beginning July 1, 2005, adjusted annually by an amount not exceeding 5% to reflect the percentage by which benefits under Title II of the Social Security Act (42 U.S.C. 401 et seq.) are increased by the federal government to reflect changes in the cost of living, as that percentage change is reported in the Federal Register in accordance with 42 U.S.C. 415(a)(1)(D); or</text> </level> </level> <level label="ii"> <text>If on or before June 30, 2002, the federal Centers for Medicare and Medicaid Services do not approve the Department’s application for an amendment to the State’s existing § 1115 demonstration waiver necessary to implement the Maryland Pharmacy Discount Program established under § 15–124.1 of this subtitle:</text> <level label="1"> <text>Beginning July 1, 2003, $50 per month;</text> </level> <level label="2"> <text>Beginning July 1, 2004, $60 per month; and</text> </level> <level label="3"> <text>Beginning July 1, 2005, adjusted annually by an amount not exceeding 5% to reflect the percentage by which benefits under Title II of the Social Security Act (42 U.S.C. 401 et seq.) are increased by the federal government to reflect changes in the cost of living, as that percentage change is reported in the Federal Register in accordance with 42 U.S.C. 415(a)(1)(D).</text> </level> </level> </level> <level label="4"> <text>The Secretary shall adopt regulations to implement this subsection.</text> </level> </level> <level label="f"> <text>Subject to the confidentiality requirements of State and federal law, the courts of this State shall admit a certified copy of a 206N form, also known as a long–term care transaction form, into evidence.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-109.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Department, in consultation with the Office of the Attorney General, shall:</text> <level label="1"> <text>Develop and implement a plan for making the advance directive information sheet developed under § 5–615 of this article widely available; and</text> </level> <level label="2"> <text>Make the information sheet described in item (1) of this subsection available in a conspicuous location in each local health department, in each local department of social services, and in community health centers.</text> </level> </level> <level label="b"> <text>The Department shall implement the plan on or before January 1, 2017.</text> </level> <level label="c"> <text>During the development of the plan under subsection (a) of this section and the information sheet under § 5–615 of this article, the Office of the Attorney General shall consult with any interested party including the State Advisory Council on Serious Illness Care.</text> </level> <level label="d"> <text>The Department shall offer:</text> <level label="1"> <text>The information sheet developed under § 5–615 of this article as part of the monthly enrollment packet mailed to a recipient by the enrollment broker; and</text> </level> <level label="2"> <text>The use of electronic advance directives to a recipient through an advance directives service that:</text> <level label="i"> <text>Is approved by the Maryland Health Care Commission and the Department; and</text> </level> <level label="ii"> <text>Meets the technology, security, and privacy standards established by the Maryland Health Care Commission.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-109.2" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>To the extent authorized by federal law or regulation, if a Program recipient who is at least 21 years old but is under the age of 65 years is incarcerated or is admitted to an institution for the treatment of mental disease, the Department:</text> <level label="1"> <text>Shall suspend Program benefits for that individual while the individual is incarcerated or is in the institution; and</text> </level> <level label="2"> <text>May not terminate Program benefits for that individual based on the incarceration of the individual or on the admission of the individual to the institution.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-110" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Department shall reimburse acute general and chronic care hospitals that participate in the Program for care provided to Program recipients in accordance with rates that the Health Services Cost Review Commission approves under Title 19, Subtitle 2 of this article, if the United States Department of Health and Human Services approves this method of reimbursement.</text> </section> <section article="ghg" article_name="Health - General" number="15-111" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Department may authorize reimbursement of a licensed day care center for the elderly or medically handicapped adults for medical care that the center provides to a Program recipient who is certified as requiring nursing home care.</text> </level> <level label="b"> <level label="1"> <text>Reimbursement under this section is subject to the availability of federal funds.</text> </level> <level label="2"> <text>The reimbursement rate for medical day care:</text> <level label="i"> <text>May not exceed a maximum per diem rate established by regulation of the Department; and</text> </level> <level label="ii"> <text>Shall cover the following:</text> <level label="1"> <text>Administrative overhead;</text> </level> <level label="2"> <text>Drugs, supplies, and equipment;</text> </level> <level label="3"> <text>Food;</text> </level> <level label="4"> <text>Medical services;</text> </level> <level label="5"> <text>Staff; and</text> </level> <level label="6"> <text>Transportation.</text> </level> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-112" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>After consultation with the State Board of Pharmacy, the Secretary may authorize reimbursement of a physician for the dispensing of drugs to Program recipients, on the same basis as a licensed pharmacist if:</text> <level label="1"> <text>The physician dispenses drugs on a regular basis in the physician’s office; and</text> </level> <level label="2"> <text>There is no pharmacy within 10 miles of that office.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-113" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “incarcerated individual of a public institution” has the meaning stated in Title 42, § 435.1009 of the Code of Federal Regulations (1978 edition).</text> </level> <level label="b"> <level label="1"> <text>If an incarcerated individual of a public institution is eligible for federally funded Medicaid benefits, the Department shall pay the custodial authority for any medical care that is provided to the incarcerated individual during the month when the individual became an incarcerated individual.</text> </level> <level label="2"> <text>Payments under this subsection shall be made in accordance with applicable rules and regulations for the Program.</text> </level> </level> <level label="c"> <text>The Department shall be reimbursed for the nonfederal cost of medical care by either the State or local authority that is responsible for the incarcerated individual of a public institution.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-114" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “related institution” includes any of the following facilities, as classified from time to time by law, rule, or regulation:</text> <level label="1"> <text>A comprehensive care facility;</text> </level> <level label="2"> <text>An extended care facility;</text> </level> <level label="3"> <text>An intermediate care facility; and</text> </level> <level label="4"> <text>A skilled nursing facility.</text> </level> </level> <level label="b"> <text>This section applies only to the extent that federal funds are available for reimbursement under this section.</text> </level> <level label="c"> <text>Except as provided in subsection (f) of this section, and in accordance with subsection (e) of this section, the Department shall reimburse each hospital–based related institution that:</text> <level label="1"> <text>Is a distinct part of an acute or chronic hospital; and</text> </level> <level label="2"> <text>On and after July 1, 1980, is licensed as a related institution.</text> </level> </level> <level label="d"> <level label="1"> <text>The Health Services Cost Review Commission shall determine rates for fiscal years 1986, 1987, 1988, and 1989 for purposes of the reimbursement formula established under subsection (e) of this section and shall inform the Department of the reimbursement rates prior to the beginning of the respective fiscal year.</text> </level> <level label="2"> <text>The rates determined by the Health Services Cost Review Commission under this section shall be the rates that would have been in effect during the respective fiscal year if the hospital–based related institution had remained under the full rate jurisdiction of the Health Services Cost Review Commission.</text> </level> </level> <level label="e"> <text>The reimbursement required by this section shall be in accordance with the following formula:</text> <level label="1"> <text>For the period from July 1, 1985 through June 30, 1986, a per diem rate calculated as the sum of:</text> <level label="i"> <text>80% of the rate determined by the Health Services Cost Review Commission under subsection (d) of this section; and</text> </level> <level label="ii"> <text>20% of the per diem rate of the hospital–based related institution determined under the Program regulations applicable to skilled and intermediate care nursing facilities.</text> </level> </level> <level label="2"> <text>For the period from July 1, 1986 through June 30, 1987, a per diem rate calculated as the sum of:</text> <level label="i"> <text>60% of the rate determined by the Health Services Cost Review Commission under subsection (d) of this section; and</text> </level> <level label="ii"> <text>40% of the per diem rate of the hospital–based related institution determined under the Program regulations applicable to skilled and intermediate care nursing facilities.</text> </level> </level> <level label="3"> <text>For the period from July 1, 1987 through June 30, 1988, a per diem rate calculated as the sum of:</text> <level label="i"> <text>40% of the rate determined by the Health Services Cost Review Commission under subsection (d) of this section; and</text> </level> <level label="ii"> <text>60% of the per diem rate of the hospital–based related institution determined under the Program regulations applicable to skilled and intermediate care nursing facilities.</text> </level> </level> <level label="4"> <text>For the period from July 1, 1988 through June 30, 1989, a per diem rate calculated as the sum of:</text> <level label="i"> <text>20% of the rate determined by the Health Services Cost Review Commission under subsection (d) of this section; and</text> </level> <level label="ii"> <text>80% of the per diem rate of the hospital–based related institution determined under the Program regulations applicable to skilled and intermediate care nursing facilities.</text> </level> </level> <level label="5"> <text>Beginning July 1, 1989, the Department shall reimburse at rates determined under the Program regulations applicable to skilled and intermediate care nursing facilities.</text> </level> </level> <level label="f"> <level label="1"> <text>In this subsection, “management firm” means an organization that:</text> <level label="i"> <text>Is intended to have or has full responsibility and control for the day–to–day operations of a nursing home or related institution; and</text> </level> <level label="ii"> <text>Is under contract with:</text> <level label="1"> <text>An applicant for a license from the Secretary to establish, operate, or continue the operation of an existing nursing home or related institution; or</text> </level> <level label="2"> <text>A holder of a license from the Secretary to operate a nursing home or related institution.</text> </level> </level> </level> <level label="2"> <text>The Department may not reimburse a nursing home or related institution if the nursing home or related institution or a management firm of a nursing home or related institution knowingly employs or retains as a consultant an individual who, for an activity described in § 9–314(b)(8), (9), or (10) of the Health Occupations Article, has:</text> <level label="i"> <text>Surrendered a nursing home administrator license under § 9–313 of the Health Occupations Article; or</text> </level> <level label="ii"> <text>Had a nursing home administrator license revoked under § 9–314 of the Health Occupations Article.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-114.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Emergency medical services provider” has the meaning stated in § 13–561 of the Education Article.</text> </level> <level label="3"> <text>“Emergency service transporter” means a public entity or volunteer fire, rescue, or emergency medical service that provides emergency medical services.</text> </level> <level label="4"> <text>“Low–acuity health condition” means an illness, an injury, or a condition serious enough that a reasonable person would seek care immediately, but not so severe as to require emergency room care.</text> </level> <level label="5"> <text>“Mobile integrated health service” means a community–based preventive, primary, chronic, preadmission, or postadmission health care service or transport provided by an emergency medical services provider to an individual.</text> </level> </level> <level label="b"> <level label="1"> <text>Subject to paragraph (2) of this subsection, if an emergency service transporter charges for its services and requests reimbursement from the Program, the Department shall reimburse the emergency service transporter, in an amount as specified by regulations adopted by the Department, for the cost of:</text> <level label="i"> <text>Transportation the emergency service transporter provides to a Program recipient to a facility in response to a 911 call; and</text> </level> <level label="ii"> <text>Medical services the emergency service transporter provides to the Program recipient in response to a 911 call.</text> </level> </level> <level label="2"> <text>The Department shall:</text> <level label="i"> <text>Increase the amount of reimbursement authorized under paragraph (1) of this subsection for the cost of transportation and medical services by $50 in fiscal year 2023; and</text> </level> <level label="ii"> <text>Pay at least the amount established under item (i) of this paragraph in each subsequent fiscal year.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>Subject to paragraph (3) of this subsection, the Department shall reimburse an emergency service transporter for mobile integrated health services provided to a Program recipient in an amount as specified by regulations adopted by the Department that is at least $100 per interaction.</text> </level> <level label="2"> <text>The services subject to reimbursement under paragraph (1) of this subsection shall include:</text> <level label="i"> <text>Health care services, including health assessments, remote medical diagnostics, chronic disease monitoring and education, medication compliance, immunizations and vaccinations, laboratory specimen collection, hospital discharge follow–up care, and minor medical procedures, provided by an emergency medical services provider that are:</text> <level label="1"> <text>Within the scope of practice of the emergency medical services provider;</text> </level> <level label="2"> <text>Provided in a home or another community–based setting to a Program recipient who does not require emergency medical transport; and</text> </level> <level label="3"> <text>Consistent with the protocols issued by the Emergency Medical Services Board; and</text> </level> </level> <level label="ii"> <text>Transportation provided by the emergency service transporter to a Program recipient with a low–acuity health condition to a location in which urgent health care services are provided to individuals.</text> </level> </level> <level label="3"> <text>The Department shall:</text> <level label="i"> <text>Increase the amount of reimbursement authorized under paragraph (1) of this subsection for the cost of transportation and medical services by $50 in fiscal year 2023; and</text> </level> <level label="ii"> <text>Pay at least the amount established under item (i) of this paragraph in each subsequent fiscal year.</text> </level> </level> </level> <level label="d"> <text>The Department shall adopt any regulations necessary to carry out this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-114.2" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <level label="i"> <text>“Applied behavior analysis” means the design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvements in human behavior.</text> </level> <level label="ii"> <text>“Applied behavior analysis” includes the direct observations, measurement, and functional analysis of the relations between environment and behavior.</text> </level> </level> <level label="3"> <text>“Autism spectrum disorder” means a group of developmental disorders:</text> <level label="i"> <text>Characterized by persistent deficits in social communication and social interaction across multiple contexts;</text> </level> <level label="ii"> <text>Characterized by restricted, repetitive patterns of behavior, interests, or activities; and</text> </level> <level label="iii"> <text>Whose symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.</text> </level> </level> <level label="4"> <text>“Behavior technician” means an individual who:</text> <level label="i"> <text>Delivers applied behavior analysis services that are provided to individuals with autism spectrum disorder under the supervision of:</text> <level label="1"> <text>A licensed psychologist;</text> </level> <level label="2"> <text>A board certified behavior analyst–doctoral; or</text> </level> <level label="3"> <text>A board certified behavior analyst; and</text> </level> </level> <level label="ii"> <text>Meets the requirements for providing behavior analysis services under the Program established by the Department in regulation.</text> </level> </level> <level label="5"> <text>“Board certified behavior analyst” means a licensed professional who:</text> <level label="i"> <text>Renders and provides direction for applied behavior analysis services that are provided to individuals with autism spectrum disorder; and</text> </level> <level label="ii"> <text>Has obtained a Board Certified Behavior Analyst certification.</text> </level> </level> <level label="6"> <text>“Board certified behavior analyst–doctoral” means a licensed professional who:</text> <level label="i"> <text>Renders and provides direction for applied behavior analysis treatments that are provided to individuals with autism spectrum disorder; and</text> </level> <level label="ii"> <text>Has obtained a Board Certified Behavior Analyst–Doctoral certification.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>The Department shall provide reimbursement for applied behavior analysis services provided by behavior technicians to Program recipients with autism spectrum disorder.</text> </level> <level label="2"> <text>Except as provided under paragraph (3) of this subsection, the Department may not require as a condition of reimbursement under the Program that an individual receive a certification from a credentialing entity recognized by the Department to provide applied behavior analysis services as a behavior technician.</text> </level> <level label="3"> <text>The Department may require as a condition of reimbursement under the Program that an individual obtain a current certification issued by a credentialing entity recognized by the Department to provide applied behavior analysis services as a behavior technician within 150 days after the individual begins providing applied behavior analysis services to Program recipients as a behavior technician and maintain the certification.</text> </level> </level> <level label="c"> <text>The Department shall adopt regulations necessary to carry out this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-115" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Department may not place a Program recipient in a skilled or intermediate nursing facility if, because of the condition of the Program recipient, the placement would cause undue risk to the Program recipient.</text> </level> <level label="b"> <text>To provide a basis for evaluating the placement of Program recipients who need skilled or intermediate nursing care in skilled or intermediate nursing facilities, a Program recipient may be placed only in a nursing facility that has a transfer agreement with a general hospital.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-116" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Department shall reimburse skilled nursing facilities for services provided to indigent or medically indigent patients under the age of 21 years.</text> </section> <section article="ghg" article_name="Health - General" number="15-117" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “leave of absence” includes:</text> <level label="1"> <text>A visit with friends or relatives; and</text> </level> <level label="2"> <text>A leave to participate in a State approved therapeutic or rehabilitative program.</text> </level> </level> <level label="b"> <text>To ensure that a bed is reserved for a Program recipient who is on leave of absence from a nursing facility that has made a provider agreement with the Department, the facility shall receive payment for each day that the Program recipient is absent and a bed is reserved and made available for the return of that Program recipient.</text> </level> <level label="c"> <level label="1"> <text>Payments under subsection (b) of this section may not be made for more than 18 days in any calendar year.</text> </level> <level label="2"> <text>Notwithstanding any rule or regulation, a leave of absence is not subject to any requirement that it may not exceed a particular number of days a visit, except that the leave of absence may not exceed a total of 18 days during any calendar year.</text> </level> </level> <level label="d"> <text>Payments required under this section:</text> <level label="1"> <text>Shall be made according to the per diem payment procedures that the Department sets; and</text> </level> <level label="2"> <text>May not include payment for nursing services.</text> </level> </level> <level label="e"> <text>A nursing facility may not make additional charges against a Program recipient because the Program recipient is absent temporarily from the nursing facility.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-118" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>Unless the prescriber directs otherwise on the form or on an attached signed certification of need, the generic form of the drug authorized under § 12-504 of the Health Occupations Article shall be used to fill the prescription.</text> </level> <level label="2"> <text>If the appropriate generic drug is not generally available, the Department may waive the requirement for generic substitution under paragraph (1) of this subsection.</text> </level> </level> <level label="b"> <level label="1"> <text>Except as provided under paragraph (2) of this subsection, the Program shall establish maximum reimbursement levels for the drug products for which there is a generic equivalent authorized under § 12-504 of the Health Occupations Article, based on the cost of the generic product.</text> </level> <level label="2"> <text>If a prescriber directs a specific brand name drug, the reimbursement level shall be based on the cost of the brand name product.</text> </level> </level> <level label="c"> <level label="1"> <text>Except as provided under paragraph (4) of this subsection and unless the change is made by an emergency regulation, the Program shall notify all pharmacies under contract with the Program in writing of changes in the Pharmaceutical Benefit Program rules or requirements at least 30 days before the change is effective.</text> </level> <level label="2"> <text>Changes that require 30 days’ advance written notice under paragraph (1) of this subsection are:</text> <level label="i"> <text>Exclusion of coverage for classes of drugs as specified by contract;</text> </level> <level label="ii"> <text>Changes in prior or preauthorization procedures; and</text> </level> <level label="iii"> <text>Selection of new prescription claims processors.</text> </level> </level> <level label="3"> <text>If the Program fails to provide advance notice as required under paragraph (1) of this subsection, it shall honor and pay in full any claim under the Program rules or requirements that existed before the change for 30 days after the postmarked date of the notice.</text> </level> <level label="4"> <text>Notwithstanding any other provision of law, the notice requirements of this subsection do not apply to the addition of new generic drugs authorized under § 12-504 of the Health Occupations Article.</text> </level> </level> <level label="d"> <text>The Secretary shall adopt regulations to carry out the provisions of this section.</text> </level> <level label="e"> <text>Except for a prescription for a prescription drug that contains a substance listed in Schedule II or that is determined by the Secretary to present an emerging threat in the State because of increasing abuse or diversion, the provisions of § 21-220(b)(1) of this article shall apply to the Program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-118.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Secretary may not consider drugs prescribed to treat diabetes, HIV, or AIDS to be specialty drugs for the purpose of providing services under the Program.</text> </section> <section article="ghg" article_name="Health - General" number="15-120" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>If a Program recipient has a cause of action against a person, the Department shall be subrogated to that cause of action to the extent of any payments made by the Department on behalf of the Program recipient that result from the occurrence that gave rise to the cause of action.</text> </level> <level label="b"> <level label="1"> <text>An attorney representing a Program recipient in a cause of action to which the Department has a right of subrogation shall notify the Department prior to filing a claim, commencing an action, or negotiating a settlement.</text> </level> <level label="2"> <text>The attorney shall notify the Department in advance of the resolution of a cause of action and shall allow the Department 3 business days from the receipt of the notice to establish its subrogated interest.</text> </level> <level label="3"> <text>This subsection may not be construed to create a cause of action for notifying or failing to notify the Department.</text> </level> </level> <level label="c"> <level label="1"> <text>Any Program recipient or attorney, guardian, or personal representative of a Program recipient who receives money in settlement of or under a judgment or award in a cause of action in which the Department has a subrogation claim shall, after receiving written notice of the subrogation claim, hold that money, for the benefit of the Department, to the extent required for the subrogation claim, after deducting applicable attorney’s fees and litigation costs.</text> </level> <level label="2"> <text>A person who, after written notice of a subrogation claim and possible liability under this paragraph, disposes of the money, without the written approval of the Department, is liable to the Department for any amount that, because of the disposition, is not recoverable by the Department.</text> </level> <level label="3"> <text>The Department may compromise or settle and release its subrogation claim if, in its judgment, collection of the claim will cause substantial hardship:</text> <level label="i"> <text>To the Program recipient; or</text> </level> <level label="ii"> <text>In a wrongful death action, to the surviving dependents of a deceased Program recipient.</text> </level> </level> <level label="4"> <level label="i"> <text>The Department is not liable for payment of or contribution to any attorney’s fees or litigation costs of any Program recipient or attorney, guardian, or personal representative of any Program recipient.</text> </level> <level label="ii"> <text>The deduction of applicable attorney’s fees and litigation costs under paragraph (1) of this subsection may not be considered as payment for or contribution to those fees or costs by the Department.</text> </level> </level> </level> <level label="d"> <text>Any action brought under this section is not exclusive and is independent of and in addition to any right, remedy, or cause of action available to the State, the Department, any other State agency, or a Program recipient or any other individual.</text> </level> <level label="e"> <level label="1"> <level label="i"> <text>In this subsection the following words have the meanings indicated.</text> </level> <level label="ii"> <text>“Cigarette” means any roll of tobacco wrapped in:</text> <level label="1"> <text>Paper;</text> </level> <level label="2"> <text>A substance not containing tobacco; or</text> </level> <level label="3"> <text>A substance containing tobacco which because of its appearance, the type of tobacco used in the filler, or its packaging and labeling, is likely to be used by the consumers of ordinary paper–wrapped cigarettes.</text> </level> </level> <level label="iii"> <level label="1"> <text>“Manufacturer of a tobacco product” means a designer, producer, or processor of a tobacco product engaged in the marketing or promotion of a tobacco product.</text> </level> <level label="2"> <text>“Manufacturer of a tobacco product” includes an entity not otherwise a manufacturer of a tobacco product that imports a tobacco product or otherwise holds itself out as a manufacturer of a tobacco product.</text> </level> <level label="3"> <text>“Manufacturer of a tobacco product” does not include:</text> </level> <level label="A"> <text>A grower, buyer, dealer, distributor, or wholesaler of leaf tobacco; or</text> </level> <level label="B"> <text>A retailer, distributor, or wholesaler of a tobacco product.</text> </level> </level> <level label="iv"> <text>“Smokeless tobacco” means a product that consists of cut, ground, powdered, or leaf tobacco that is intended to be placed in the oral cavity.</text> </level> <level label="v"> <text>“Tobacco product” means cigarettes or smokeless tobacco.</text> </level> </level> <level label="2"> <text>In any action under this section or pursuant to any other right, remedy, or cause of action brought by the State against a manufacturer of a tobacco product, the causation and the amount of medical assistance expenditures attributable to the use of a tobacco product may be proved or disproved by evidence of statistical analysis, without proof of the causation or the amount of expenditures for any particular Program recipient or any other individual.</text> </level> <level label="3"> <text>Nothing contained in paragraph (2) of this subsection prohibits or limits the right of any party to introduce any other evidence, otherwise admissible, that supports or rebuts the evidence of statistical analysis described in paragraph (2) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-121" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In accordance with applicable federal law and rules and regulations, including those under Title XIX of the Social Security Act, the Department may make claim against the estate of a deceased Program recipient for the amount of any medical assistance payments under this title.</text> </level> <level label="b"> <text>The claim shall be waived by the Department if, in its judgment, enforcement of the claim will cause substantial hardship to the surviving dependents of the deceased.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-121.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>If a Program recipient has a claim for any medical, hospital or disability benefits under §§ 19-505 and 19-506 of the Insurance Article, the Department shall be subrogated to that claim to the extent of any payments made by the Department on behalf of the Program recipient that results from the occurrence that gave rise to the claim less:</text> <level label="1"> <text>Applicable attorney’s fees; and</text> </level> <level label="2"> <text>Any rights for loss of income.</text> </level> </level> <level label="b"> <level label="1"> <text>An attorney representing a Program recipient under this subtitle on a claim to which the Department has a right of subrogation shall notify the Department prior to filing the claim.</text> </level> <level label="2"> <text>This subsection may not be construed to create a cause of action for notifying or failing to notify the Department.</text> </level> </level> <level label="c"> <level label="1"> <text>Any Program recipient or attorney, guardian, or personal representative of a Program recipient who receives money for a claim to which the Department has a subrogation claim shall, after receiving written notice of the subrogation claim, hold that money, for the benefit of the Department, to the extent required for the subrogation claim, after deducting applicable attorney’s fees.</text> </level> <level label="2"> <text>A person who, after written notice of a subrogation claim from the Department and possible liability under this paragraph, disposes of the money, without the written approval of the Department, is liable to the Department for any amount that, because of the disposition, is not recoverable by the Department.</text> </level> <level label="3"> <text>The Department may compromise or settle and release its subrogation claim if, in its judgment, collection of the claim will cause substantial hardship to the Program recipient or in a wrongful death action, the surviving dependent of a deceased Program recipient.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-121.2" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>If a Program recipient has a claim for any medical, hospital, or disability benefits under §§ 19-509 and 19-510 of the Insurance Article, the Department shall be subrogated to that claim to the extent of any payments made by the Department on behalf of the Program recipient that results from the occurrence that gave rise to the claim, less applicable attorney’s fees.</text> </level> <level label="b"> <level label="1"> <text>An attorney representing a Program recipient under this subtitle on a claim to which the Department has a right of subrogation shall notify the Department prior to filing the claim.</text> </level> <level label="2"> <text>This subsection may not be construed to create a cause of action for notifying or failing to notify the Department.</text> </level> </level> <level label="c"> <level label="1"> <text>Any Program recipient, attorney, guardian, or personal representative of a Program recipient who receives money for a claim to which the Department has a subrogation claim shall, after receiving written notice of the subrogation claim, hold that money, for the benefit of the Department, to the extent required for the subrogation claim, after deducting applicable attorney’s fees.</text> </level> <level label="2"> <text>A person who, after written notice of a subrogation claim from the Department and possible liability under this paragraph, disposes of the money, without the written approval of the Department, is liable to the Department for any amount that, because of the disposition, is not recoverable by the Department.</text> </level> <level label="3"> <text>The Department may compromise or settle and release its subrogation claim if, in its judgment, collection of the claim will cause substantial hardship to the Program recipient or in a wrongful death action, the surviving dependent of a deceased Program recipient.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-121.3" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Department may assign its right of subrogation under §§ 15-120, 15-121.1, and 15-121.2 of this subtitle to a managed care organization.</text> </section> <section article="ghg" article_name="Health - General" number="15-122" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>The spouse of a Program recipient is responsible for payments for the health care needs of the Program recipient to the extent that the spouse is able to pay any of the cost of care. Except as provided in paragraph (2) of this subsection, the total liability shall be limited to the amount spent for the care under the Program.</text> </level> <level label="2"> <text>In any case in which eligibility was based on the spouse’s refusal to pay for the Program recipient’s care, the liability of the spouse may include:</text> <level label="i"> <text>The amount spent for care by the Program;</text> </level> <level label="ii"> <text>Administrative and enforcement costs incurred by the Program related to pursuing reimbursement from the spouse; and</text> </level> <level label="iii"> <text>Any penalties established by the Secretary by regulation for a violation of this section not to exceed $50 per day for each day a violation exists.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>The Secretary shall adopt rules and regulations that set standards for payment by the spouse based on the ability of the spouse to pay all or part of the cost of care. To determine reasonably the ability to pay, the Secretary shall evaluate available income, ordinary living expenses, special expenses, and assets, other than the homestead of the spouse and its appurtenances.</text> </level> <level label="2"> <text>Notwithstanding the standards established under paragraph (1) of this subsection, the spouse may also be liable for costs and penalties under subsection (a)(2) of this section.</text> </level> </level> <level label="c"> <level label="1"> <text>The Secretary may collect the money owed.</text> </level> <level label="2"> <text>The Central Collection Unit in the Department of Budget and Management shall collect delinquent accounts and debts.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-122.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “participating provider” means any facility that participates in the Program and is:</text> <level label="1"> <text>A skilled nursing facility;</text> </level> <level label="2"> <text>A comprehensive care facility; or</text> </level> <level label="3"> <text>An intermediate care facility.</text> </level> </level> <level label="b"> <text>A participating provider shall not be required to repay the State for any depreciation for which the provider has been reimbursed as an allowable expense and which could otherwise be recaptured by the State upon a sale, scrapping, trade-in, donation, exchange, demolition, or abandonment of a facility, or involuntary conversion of a facility such as condemnation, fire, theft, or other casualty.</text> </level> <level label="c"> <text>This section has no effect if its operation would cause this State to lose any federal funds.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-122.2" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “converted funds” means the amount received in payment by a person from an insurer for the cost of health services provided to a child which was not used to reimburse the Department for Medicaid costs incurred.</text> </level> <level label="b"> <text>Each year the Department may refer to the Central Collection Unit of the Department of Budget and Management for certification to the State Comptroller the name of any person who has received converted funds for the interception of any State tax refund.</text> </level> <level label="c"> <text>The Department shall notify the person certified under subsection (b) of this section that a certification has been made by the Department.</text> </level> <level label="d"> <text>The certification by the Central Collection Unit shall include, if known:</text> <level label="1"> <text>The full name of the person certified and any other names known to be used by that person;</text> </level> <level label="2"> <text>The address and the Social Security number of the person certified; and</text> </level> <level label="3"> <text>The amount of the converted funds.</text> </level> </level> <level label="e"> <text>The State Comptroller shall:</text> <level label="1"> <text>Pay to the Department any income tax refund due to the person certified in an amount not more than the amount certified by the Department;</text> </level> <level label="2"> <text>Pay to the person certified any part of the income tax refund over the amount of the converted funds; and</text> </level> <level label="3"> <text>Notify the person certified of:</text> <level label="i"> <text>The amount paid to the Department; and</text> </level> <level label="ii"> <text>The rights of the person certified under subsection (b) of this section.</text> </level> </level> </level> <level label="f"> <level label="1"> <text>On receipt of a notice of intercept from the State Comptroller, any person certified by the Department who disputes the existence or amount of the converted funds may file an appeal in accordance with Title 10 of the State Government Article.</text> </level> <level label="2"> <text>If the Department finds that an excessive amount was withheld from the person’s income tax refund, the Department promptly shall pay to the taxpayer the excess amount withheld.</text> </level> </level> <level label="g"> <text>The Comptroller shall honor refund interception requests in the following order:</text> <level label="1"> <text>A refund interception request to collect an unpaid State, county, or municipal tax;</text> </level> <level label="2"> <text>A refund interception request under § 10-113 of the Family Law Article for arrears of support payments;</text> </level> <level label="3"> <text>A refund interception request for converted funds under this subtitle; and</text> </level> <level label="4"> <text>Any other refund interception request.</text> </level> </level> <level label="h"> <text>The Secretary and the State Comptroller may adopt regulations to carry out this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-122.3" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Available income” means the portion of income of a Program recipient that the Program recipient is required to contribute to the cost of care for the Program recipient under the Program.</text> </level> <level label="3"> <text>“Disabled person” has the meaning stated in § 13–101 of the Estates and Trusts Article.</text> </level> <level label="4"> <text>“Guardian” means:</text> <level label="i"> <text>A guardian of the person; or</text> </level> <level label="ii"> <text>A guardian of the property.</text> </level> </level> <level label="5"> <text>“Guardian of the person” means a person who has been appointed by a court as a guardian of the person of a disabled person under § 13–705 of the Estates and Trusts Article.</text> </level> <level label="6"> <text>“Guardian of the property” means a person who has been appointed by a court as a guardian of the property of a disabled person under § 13–201 of the Estates and Trusts Article.</text> </level> <level label="7"> <text>“Guardianship services” means services provided to a recipient who is a disabled person by a guardian while acting in the capacity as a guardian.</text> </level> <level label="8"> <text>“Recipient” means a Program recipient who receives long–term care services and supports under the Program.</text> </level> </level> <level label="b"> <text>Subject to subsection (c) of this section, when determining the available income of a recipient who is a disabled person and has a guardian, the Department shall include as part of the personal needs allowance guardianship fees payable for guardianship services.</text> </level> <level label="c"> <text>The personal needs allowance for guardianship fees shall be as follows:</text> <level label="1"> <text>If one person is serving as both the guardian of the person and the guardian of the property of the recipient, the personal needs allowance shall be $50 per month; and</text> </level> <level label="2"> <text>If one person is serving as the guardian of the person of the recipient and a different person is serving as the guardian of the property of the recipient, the personal needs allowance shall be $50 per month for each guardian.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-123" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Convicted” includes being convicted after a plea of nolo contendere.</text> </level> <level label="3"> <text>“Fraud” includes the commission of or an attempt or conspiracy to commit the crimes of:</text> <level label="i"> <text>Concealment of medical records;</text> </level> <level label="ii"> <text>Violation of Title 8, Subtitle 5, Part II of the Criminal Law Article;</text> </level> <level label="iii"> <text>False representations relating to Medicaid health plans;</text> </level> <level label="iv"> <text>Misappropriation by a fiduciary; and</text> </level> <level label="v"> <text>Theft.</text> </level> </level> </level> <level label="b"> <text>A health care provider who is convicted of fraud in connection with the Program or a similar federal or State program is ineligible for further payment under the Program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-124.2" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “Program” means the Maryland Medbank Program established under this section.</text> </level> <level label="b"> <text>There is a Maryland Medbank Program.</text> </level> <level label="c"> <text>The purpose of the Program is to improve the health status of individuals throughout the State who lack prescription drug coverage by providing access to medically necessary prescription drugs through patient assistance programs sponsored by pharmaceutical drug manufacturers.</text> </level> <level label="d"> <level label="1"> <text>Subject to paragraph (2) of this subsection, the Program shall be administered by the Medbank of Maryland, Inc.</text> </level> <level label="2"> <text>The Medbank of Maryland, Inc. shall contract with one or more government or nonprofit entities to operate the Program.</text> </level> </level> <level label="e"> <level label="1"> <text>The Program shall be funded through a grant provided by the Department.</text> </level> <level label="2"> <text>Program funds may be used in part to:</text> <level label="i"> <text>Purchase interim supplies of prescription drugs for enrollees who have applied to participate in a manufacturer’s patient assistance program but have not yet received the approved prescription drug; and</text> </level> <level label="ii"> <text>Distribute medication to enrollees who have been approved to participate in a manufacturer’s patient assistance program.</text> </level> </level> </level> <level label="f"> <level label="1"> <text>The Medbank of Maryland, Inc. shall ensure that the Program is available to residents in each of the following geographic regions of the State:</text> <level label="i"> <text>Western Maryland;</text> </level> <level label="ii"> <text>The Eastern Shore;</text> </level> <level label="iii"> <text>The Baltimore metropolitan area;</text> </level> <level label="iv"> <text>The Maryland counties in the Washington, D.C. metropolitan area; and</text> </level> <level label="v"> <text>Southern Maryland, including Anne Arundel County.</text> </level> </level> <level label="2"> <text>Medbank of Maryland, Inc. shall be the central coordinating office for the State.</text> </level> </level> <level label="g"> <text>Eligibility for the Program shall be limited only by the criteria established by pharmaceutical manufacturers for their patient assistance programs.</text> </level> <level label="h"> <level label="1"> <text>The Department shall require detailed financial reports at least quarterly from Medbank of Maryland, Inc.</text> </level> <level label="2"> <text>The Medbank of Maryland, Inc. shall release funds to the entities that operate the Program as needed and justified by the quarterly reports filed in accordance with paragraph (1) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-124.3" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Enrollee” means an individual who is enrolled in the Program.</text> </level> <level label="3"> <text>“Medicare Modernization Act” means the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003.</text> </level> <level label="4"> <text>“Medicare Part D prescription drug benefit” means the prescription drug benefit established by the Medicare Modernization Act under Part D of the federal Medicare Program.</text> </level> <level label="5"> <text>“Prescription drug plan” means a private health plan that provides a Medicare Part D prescription drug benefit in accordance with the requirements of the Medicare Modernization Act.</text> </level> <level label="6"> <text>“Program” means the Medicare Option Prescription Drug Program established under this section.</text> </level> </level> <level label="b"> <text>There is a Medicare Option Prescription Drug Program within the Maryland Medical Assistance Program.</text> </level> <level label="c"> <text>The purpose of the Program is to:</text> <level label="1"> <text>Assist low–income Medicare eligible individuals to make a seamless transition to, and coordinate prescription drug coverage with, the Medicare Part D prescription drug benefit; and</text> </level> <level label="2"> <text>Minimize the cost–sharing burden on the individuals.</text> </level> </level> <level label="d"> <text>The Program shall be administered and operated by the Department as permitted by federal law or waiver.</text> </level> <level label="e"> <level label="1"> <text>The Program shall be open to any individual who:</text> <level label="i"> <text>Is a resident of the State;</text> </level> <level label="ii"> <text>Is a Medicare beneficiary;</text> </level> <level label="iii"> <text>Is not enrolled in a Medicare Advantage Plan or other public or private insurance program, except for Medicaid and the Maryland Pharmacy Assistance Program, that provides prescription drug benefits at the time that the individual applies for enrollment in the Program;</text> </level> <level label="iv"> <text>Has an annual household income below 150 percent of the federal poverty level; and</text> </level> <level label="v"> <text>Meets the asset test established by the Medicare Modernization Act under Medicare Part D.</text> </level> </level> <level label="2"> <text>Individuals who are dually eligible for Medicare and Medicaid, or Medicare and the Maryland Pharmacy Assistance Program, may be enrolled automatically in the Program, provided that they may elect to opt out of the Program.</text> </level> <level label="3"> <text>Enrollment in the Program for individuals who are dually eligible for Medicare and Medicaid shall begin not later than the date on which the auto–enrollment period for the federal Medicare Part D Program begins.</text> </level> <level label="4"> <text>The Department shall determine the procedures for automatic enrollment in, and election to opt out of, the Program.</text> </level> <level label="5"> <text>Individuals who meet the eligibility requirements of paragraph (1) of this subsection but who are not dually eligible for Medicare and either Medicaid or the Maryland Pharmacy Assistance Program may apply for enrollment in the Medicare Option Prescription Drug Program by submitting an application to the Department.</text> </level> </level> <level label="f"> <text>The Department may:</text> <level label="1"> <text>Enter into a contract with one or more prescription drug plans to coordinate the prescription drug benefits provided under the Program and the Medicare Part D prescription drug benefit;</text> </level> <level label="2"> <text>Require a pharmaceutical manufacturer to provide rebates in an amount not less than the rebates provided to the Medicaid Program under § 1927(c) of Title XIX of the Social Security Act (42 U.S.C. § 1396r–8) as a condition of the pharmaceutical manufacturer’s products being available to enrollees;</text> </level> <level label="3"> <text>Enroll eligible individuals into a prescription drug plan under contract with the Department, with an opt–out provision at the individual’s discretion;</text> </level> <level label="4"> <text>Specify procedures for individuals to apply for enrollment in the Program;</text> </level> <level label="5"> <text>Contract with a private entity to assist in administration of the Program or negotiations with prescription drug plans; and</text> </level> <level label="6"> <text>Pay all or part of the premiums, deductibles, coinsurance payments, and copayments required under the Medicare Part D Program for enrollees.</text> </level> </level> <level label="g"> <text>Subject to available funds, the Program established under this subtitle shall provide benefits to the maximum number of individuals eligible for enrollment in the Program.</text> </level> <level label="h"> <text>The Secretary shall adopt regulations to implement the Program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-125" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Children” means individuals under the age of 12 years.</text> </level> <level label="3"> <text>“Youth” means an individual at least 12 years old and under the age of 22 years.</text> </level> </level> <level label="b"> <text>The Department is the agency of this State to administer a program of services for children and youth who have or are suspected of having special health care needs.</text> </level> <level label="c"> <text>The purpose of this program is to provide reimbursement for medical, diagnostic, corrective, and other services and care to children and youth who have or are suspected of having special health care needs.</text> </level> <level label="d"> <text>The Department may:</text> <level label="1"> <text>Prepare and administer detailed plans for these purposes;</text> </level> <level label="2"> <text>Adopt rules and regulations for administering these plans;</text> </level> <level label="3"> <text>Receive and, in accordance with these plans, spend all funds made available to the Department for these purposes; and</text> </level> <level label="4"> <text>Cooperate with the federal government in extending and improving these services and in administering these plans.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-126" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Secretary shall provide educational programs to meet the needs of each physically or mentally handicapped child in the custody of the Department. The cost for each child shall be included and identified in the budget of the Department as submitted to the General Assembly by the Governor.</text> </section> <section article="ghg" article_name="Health - General" number="15-128" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Department may provide reimbursement, under the Maryland Medical Assistance Program, for services provided by a hospice care program, as defined in § 19-901 of this article.</text> </section> <section article="ghg" article_name="Health - General" number="15-129" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “durable medical equipment” means durable medical equipment listed in the medical assistance provider fee manual, as provided in regulations adopted by the Department.</text> </level> <level label="b"> <text>To determine whether the prices charged for durable medical equipment provided to Program recipients are reasonable, the Department shall establish regulations and procedures for reviewing the prices of durable medical equipment every 3 years.</text> </level> <level label="c"> <text>The Department, to the extent feasible and appropriate, shall recover all durable medical equipment from Program recipients that:</text> <level label="1"> <text>Was purchased by the Department; and</text> </level> <level label="2"> <text>Is no longer required by the recipient.</text> </level> </level> <level label="d"> <text>Except as provided in subsection (e) of this section and to the extent feasible and appropriate, the Department shall reuse the durable medical equipment recovered under subsection (c) of this section to meet the needs of other Program recipients for the same durable medical equipment.</text> </level> <level label="e"> <text>If the durable medical equipment recovered under subsection (c) of this section is not in a condition that would enable another Program recipient to use it, the Department may give the equipment to any organization that will:</text> <level label="1"> <text>Repair or attempt to repair the equipment; and</text> </level> <level label="2"> <text>Provide the equipment at no charge to other persons who require the same equipment.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-130" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “seriously emotionally disturbed” means a condition that is:</text> <level label="1"> <text>Manifest in an individual younger than 18 years or, if the individual is in a residential treatment center, younger than 21 years;</text> </level> <level label="2"> <text>Diagnosed according to the current diagnostic classification system that is recognized by the Secretary; and</text> </level> <level label="3"> <text>Characterized by a functional impairment that substantially interferes with or limits the child’s role or functioning in the family, school, or community activities.</text> </level> </level> <level label="b"> <level label="1"> <text>The Department shall apply to the Health Care Financing Administration of the federal Department of Health and Human Services for a home– and community–based services waiver under § 1915(c) of the federal Social Security Act in order to receive federal matching funds for services to seriously emotionally disturbed individuals who would otherwise require institutionalization in a residential treatment center.</text> </level> <level label="2"> <text>The Department shall apply to the Health Care Financing Administration of the federal Department of Health and Human Services for a home– and community–based services waiver under § 1915(c) of the federal Social Security Act in order to receive federal matching funds for services to autistic children aged 1 through 21 years who would otherwise require institutionalization in an institution for the developmentally disabled.</text> </level> </level> <level label="c"> <text>In accordance with subsection (b)(1) and (2) of this section, the services to be provided for seriously emotionally disturbed individuals or autistic children may include:</text> <level label="1"> <text>Respite services;</text> </level> <level label="2"> <text>Family training and education;</text> </level> <level label="3"> <text>Day treatment services;</text> </level> <level label="4"> <text>Therapeutic integration services;</text> </level> <level label="5"> <text>Intensive individual support services;</text> </level> <level label="6"> <text>Therapeutic living services;</text> </level> <level label="7"> <text>Intensive in–home intervention services; and</text> </level> <level label="8"> <text>Specialized case management services.</text> </level> </level> <level label="d"> <text>The State matching funds required to cover the Medicaid costs under the waiver for autistic children shall be certified or otherwise provided by the Maryland State Department of Education, local school systems, and local lead agencies.</text> </level> <level label="e"> <text>The State matching funds required to cover the Medicaid costs under the waiver for seriously emotionally disturbed individuals shall be certified or otherwise provided by the Maryland State Department of Education, local school systems, local lead agencies, and the Behavioral Health Administration.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-130.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Department shall apply to the Centers for Medicare and Medicaid Services of the federal Department of Health and Human Services for a psychiatric residential treatment demonstration waiver if the Centers announce in the Federal Register that the Centers are accepting applications for such a waiver.</text> </level> <level label="b"> <text>The waiver application required by subsection (a) of this section shall:</text> <level label="1"> <text>Provide for services for a minimum of 150 individuals; or</text> </level> <level label="2"> <text>Provide for services for the maximum number of individuals that the Centers for Medicare and Medicaid Services allows, if the maximum number of individuals that the Centers allow to receive services under the waiver is fewer than 150 individuals.</text> </level> </level> <level label="c"> <text>During the waiver application process, the Department shall conduct an analysis of both the short-term and long-term costs and benefits of implementing the waiver.</text> </level> <level label="d"> <text>The Department shall report to the General Assembly, in accordance with § 2-1257 of the State Government Article, every 6 months concerning the status of the Department’s application required under this section until the waiver is approved or denied.</text> </level> <level label="e"> <level label="1"> <text>If the Centers for Medicare and Medicaid Services approve the waiver application required under this section, the Department shall report to the General Assembly, in accordance with § 2-1257 of the State Government Article, on its decision on whether to implement the waiver.</text> </level> <level label="2"> <text>The report required under this subsection shall include a summary of the analysis required under subsection (c) of this section.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-131" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Department shall investigate development of integrated care systems and the feasibility and desirability of applying for a home- and community-based services waiver in order to maximize federal matching funds for the provision of services to adults who:</text> <level label="1"> <text>Have functional disabilities, including Alzheimer’s disease and related disorders;</text> </level> <level label="2"> <text>Have family income not greater than 200% of the federal poverty level; and</text> </level> <level label="3"> <text>Would otherwise require nursing home institutionalization.</text> </level> </level> <level label="b"> <text>The services covered under the waiver under this section may include:</text> <level label="1"> <text>Routine and emergency respite care;</text> </level> <level label="2"> <text>Adult day care;</text> </level> <level label="3"> <text>Personal care;</text> </level> <level label="4"> <text>Case management; and</text> </level> <level label="5"> <text>Homemaker services.</text> </level> </level> <level label="c"> <text>The Department may place a reasonable limit on the number of individuals or on the geographic area of the State included in the waiver under this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-132" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following terms have the meanings indicated.</text> </level> <level label="2"> <text>“Assisted living program” has the meaning stated in § 19–1801 of this article.</text> </level> <level label="3"> <text>“Assisted living services” means services provided by an assisted living program as defined in regulations adopted by the Department.</text> </level> <level label="4"> <text>“Case management services” means services that assist waiver eligible individuals in gaining access to needed waiver services and other needed medical, social, housing, and other supportive services.</text> </level> <level label="5"> <text>“Health related care and services” includes:</text> <level label="i"> <text>24–hour supervision and observation by a licensed care provider;</text> </level> <level label="ii"> <text>Medication administration;</text> </level> <level label="iii"> <text>Inhalation therapy;</text> </level> <level label="iv"> <text>Bladder and catheter management;</text> </level> <level label="v"> <text>Assistance with suctioning; or</text> </level> <level label="vi"> <text>Assistance with treatment of skin disorders and dressings.</text> </level> </level> <level label="6"> <text>“Home health care services” means those services defined in § 19–401 of this article and in 42 C.F.R. 440.70.</text> </level> <level label="7"> <text>“Medically and functionally impaired” means an individual who is assessed by the Department to require services provided by a nursing facility as defined in this section, and who, but for the receipt of these services, would require admission to a nursing facility within 30 days.</text> </level> <level label="8"> <text>“Nursing facility” means a facility that provides skilled nursing care and related services, rehabilitation services, and health related care and services above the level of room and board needed on a regular basis in accordance with § 1919 of the federal Social Security Act.</text> </level> <level label="9"> <text>“Waiver” means a home– and community–based services waiver under § 1915(c) of the federal Social Security Act, submitted by the Department to the Centers for Medicare and Medicaid Services.</text> </level> <level label="10"> <text>“Waiver services” means the services covered under an approved waiver that:</text> <level label="i"> <text>Are needed and chosen by an eligible waiver participant as an alternative to admission to or continued stay in a nursing facility;</text> </level> <level label="ii"> <text>Are part of a plan of service approved by the program;</text> </level> <level label="iii"> <text>Assure the waiver participant’s health and safety in the community; and</text> </level> <level label="iv"> <text>Cost no more per capita to receive services in the community than in a nursing facility.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>If authorized by the Centers for Medicare and Medicaid Services, an individual shall be determined medically eligible to receive services if the individual requires:</text> <level label="i"> <text>Skilled nursing care or other related services;</text> </level> <level label="ii"> <text>Rehabilitation services; or</text> </level> <level label="iii"> <text>Health–related services above the level of room and board that are available only through nursing facilities, including individuals who because of severe cognitive impairments or other conditions:</text> <level label="1"> <level label="A"> <text>Are currently unable to perform at least two activities of daily living without hands–on assistance or standby assistance from another individual; and</text> </level> </level> <level label="B"> <text>Have been or will be unable to perform at least two activities of daily living for a period of at least 90 days due to a loss of functional capacity; or</text> </level> <level label="2"> <text>Need substantial supervision for protection against threats to health and safety due to severe cognitive impairment.</text> </level> </level> </level> <level label="2"> <text>The Department shall adopt regulations to carry out the provisions of this subsection.</text> </level> </level> <level label="c"> <text>The Department’s waiver shall include the following:</text> <level label="1"> <text>A cap on waiver participation of not fewer than 7,500 individuals;</text> </level> <level label="2"> <text>A plan for waiver participation of not fewer than 7,500 individuals;</text> </level> <level label="3"> <text>Financial eligibility criteria which include:</text> <level label="i"> <text>The current federal and State medical assistance long–term care rules for using services provided by a nursing facility, per §§ 1902, 1919, and 1924 of the federal Social Security Act, and applicable regulations adopted by the Department;</text> </level> <level label="ii"> <text>Medically needy individuals using services provided by a nursing facility under the current federal and State medical assistance eligibility criteria governed by regulations adopted by the Department and § 1919 of the federal Social Security Act; and</text> </level> <level label="iii"> <text>Categorically needy individuals with income up to 300% of the applicable payment rate for supplemental security income;</text> </level> </level> <level label="4"> <text>Waiver services that include at least the following:</text> <level label="i"> <text>Assisted living services;</text> </level> <level label="ii"> <text>Case management services;</text> </level> <level label="iii"> <text>Family training;</text> </level> <level label="iv"> <text>Dietitian and nutritionist services;</text> </level> <level label="v"> <text>Medical day care services; and</text> </level> <level label="vi"> <text>Senior center plus services;</text> </level> </level> <level label="5"> <text>The opportunity to provide eligible individuals with waiver services under this section as soon as they are available without waiting for placement slots to open in the next fiscal year;</text> </level> <level label="6"> <text>An increase in participant satisfaction;</text> </level> <level label="7"> <text>The forestalling of functional decline;</text> </level> <level label="8"> <text>A reduction in Medicaid expenditures by reducing utilization of services; and</text> </level> <level label="9"> <text>The enhancement of compliance with the decision of the United States Supreme Court in the case of Olmstead v. L.C. (1999) by offering cost–effective community–based services in the most appropriate setting.</text> </level> </level> <level label="d"> <text>This section may not be construed to affect, interfere with, or interrupt any services reimbursed through the Program under this title.</text> </level> <level label="e"> <level label="1"> <level label="i"> <text>If the Department maintains a waiting list or registry, each month the Department shall send a waiver application:</text> <level label="1"> <text>If there are fewer than 600 individuals on the waiting list or registry, to all individuals on the waiting list or registry; and</text> </level> <level label="2"> <text>If there are 600 or more individuals on the waiting list or registry, to at least 600 individuals on the waiting list or registry.</text> </level> </level> <level label="ii"> <text>A waiver application sent under subparagraph (i) of this paragraph shall state clearly and conspicuously that:</text> <level label="1"> <text>The applicant must submit the application within 6 weeks after receiving the application; and</text> </level> <level label="2"> <text>The applicant is required to meet all of the eligibility criteria for participation in the waiver within 6 months after submitting the application.</text> </level> </level> </level> <level label="2"> <text>If a person determined to be eligible to receive waiver services under this section desires to receive waiver services and an appropriate placement is available, the Department shall authorize the placement.</text> </level> </level> <level label="f"> <text>The Department, in consultation with representatives of the affected industry and advocates for waiver candidates, and with the approval of the Department of Aging, shall adopt regulations to implement this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-132.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “self-employed provider” means an individual who:</text> <level label="1"> <text>Provides health care services as an attendant, personal care aide, personal care provider, or respite care worker to Program recipients participating in:</text> <level label="i"> <text>The Home- and Community-Based Services Waiver for Older Adults Program; or</text> </level> <level label="ii"> <text>The Medical Assistance Personal Care Program; and</text> </level> </level> <level label="2"> <text>Is not employed by an agency.</text> </level> </level> <level label="b"> <text>To the extent allowed under federal law, the Department shall provide voluntary withholding of federal income taxes under the Internal Revenue Code and State income taxes under Title 10 of the Tax - General Article for self-employed providers.</text> </level> <level label="c"> <text>Nothing in this section shall be construed to alter a self-employed provider’s contractual relationship with the Department or to confer to the self-employed provider any status of employment or benefits commensurate with that status.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-133" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The State shall apply to the Health Care Financing Administration of the United States Department of Health and Human Services for grants to assist states in improving home– and community–based service systems, including:</text> <level label="1"> <text>Real choice system change grants;</text> </level> <level label="2"> <text>Nursing facility transition grants and “access housing” grants; and</text> </level> <level label="3"> <text>Community–based attendant services with consumer control grants.</text> </level> </level> <level label="b"> <text>The Department shall seek input from eligible individuals, the individuals’ representatives, and service providers in developing and implementing the Program.</text> </level> <level label="c"> <text>On or before July 1, 2001, the Department shall notify the Health Care Financing Administration of the United States Department of Health and Human Services of Maryland’s intent to expand the current Medicaid home– and community–based waiver for adults with physical disabilities, under § 1915(c) of the federal Social Security Act to redirect funds to develop appropriate funding for this Program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-134" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>If the Department applies for a Medical Assistance Program waiver, modifies or amends an existing Medical Assistance Program waiver, or amends the Medicaid State Plan, the Department shall give notice of the application or amendment by:</text> <level label="1"> <text>Publication in the Maryland Register; and</text> </level> <level label="2"> <text>Submission of the application or amendment to the Medicaid Advisory Committee for discussion at a Medicaid Advisory Committee meeting.</text> </level> </level> <level label="b"> <text>For 30 days following publication of any notice published under subsection (a) of this section, the Department shall:</text> <level label="1"> <text>Make the Medical Assistance Program waiver application or amendment to the Medicaid State Plan available to the public during business hours; and</text> </level> <level label="2"> <text>Provide an opportunity to receive public comments on the Medical Assistance Program waiver application or amendment to the Medicaid State Plan.</text> </level> </level> <level label="c"> <text>If the Department submits to the federal Centers for Medicare and Medicaid Services an amendment to the Medicaid State Plan or Medical Assistance Program waiver application, the Department shall submit a copy of the amendment or waiver application to the members of the Medicaid Advisory Committee no later than five business days after the Department submits the amendment or waiver application to the federal Centers for Medicare and Medicaid Services.</text> </level> <level label="d"> <text>Subject to the limitations of the State budget and notwithstanding any other provision of law, the following are effective on the date specified in a Maryland Register notice:</text> <level label="1"> <text>Amendments or modifications to the Medicaid State Plan or Medical Assistance Program; and</text> </level> <level label="2"> <text>Medical Assistance Program waiver applications and modifications.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-134.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “legal resident” means an individual who maintains the State as the individual’s principal establishment, home of record, or permanent home and to where, whenever absent due to uniformed services obligation, the individual intends to return.</text> </level> <level label="b"> <text>A dependent of a legal resident of the State who is determined eligible to receive home– and community–based waiver services or other waiver services from the Department under this title shall retain eligibility for the services:</text> <level label="1"> <text>Regardless of whether the legal resident leaves the State due to the legal resident’s uniformed services assignment outside the State; and</text> </level> <level label="2"> <text>If the dependent is otherwise eligible for the services.</text> </level> </level> <level label="c"> <text>If a dependent of a legal resident is on a waiting list for home– and community–based waiver services or other waiver services to be provided under this title, the Department shall allow the dependent to remain on the waiting list for services while the legal resident is outside the State due to the legal resident’s uniformed services assignment outside the State.</text> </level> <level label="d"> <text>The Department shall reinstate services provided under this title to a dependent who resides with the legal resident while the legal resident is outside the State due to the legal resident’s uniformed services assignment outside the State:</text> <level label="1"> <text>On the relocation of the dependent to the State; and</text> </level> <level label="2"> <text>If a request for services is made.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-135" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Designated protection and advocacy systems agency” means a protection and advocacy systems agency that is designated as an independent advocate for individuals with disabilities under the federal Developmental Disabilities Act.</text> </level> <level label="3"> <text>“Nursing facility” has the meaning stated in § 15–132(a)(8) of this subtitle.</text> </level> <level label="4"> <text>“Resident” means an individual receiving long–term care in a nursing facility.</text> </level> </level> <level label="b"> <level label="1"> <text>A social worker shall provide to each resident information that:</text> <level label="i"> <text>Explains the availability of services under home– or community–based waiver programs in the State that could enable the resident to live in the community;</text> </level> <level label="ii"> <text>Explains that if the resident’s care is partially or fully reimbursed by the Program, the resident may be able to receive long–term care services in the community instead of in the nursing facility;</text> </level> <level label="iii"> <text>Provides information regarding how to obtain case management services or evaluation services related to home– and community–based waiver programs or other options for receiving long–term care services in the community;</text> </level> <level label="iv"> <text>If written, is in large, easily legible type and in formats accessible to the resident; and</text> </level> <level label="v"> <text>Includes a list of legal, advocacy, and government agency resources.</text> </level> </level> <level label="2"> <text>The Department, in consultation with the State agencies that implement the home– and community–based services programs, shall prepare, distribute, and update as necessary the information required under paragraph (1) of this subsection.</text> </level> <level label="3"> <text>The information required under paragraph (1) of this subsection shall be made available to the resident:</text> <level label="i"> <text>Upon admission and discharge of the resident; and</text> </level> <level label="ii"> <text>When the resident indicates a preference to live in the community, either during the resident’s quarterly assessment or at any other time.</text> </level> </level> <level label="4"> <text>The social worker shall request that the resident sign an acknowledgment of receipt of the information provided by the social worker that shall be kept in the resident’s medical record.</text> </level> </level> <level label="c"> <text>If a resident indicates an interest in or a preference for living in the community, the nursing facility shall refer the resident to the Department, or the Department’s designee, for further assistance.</text> </level> <level label="d"> <text>The Department, or the Department’s designee, shall review the quarterly assessments submitted to the Center for Medicare and Medicaid Services of the U.S. Department of Health and Human Services by each nursing facility that participates in the Program to identify individuals indicating a preference to live in the community.</text> </level> <level label="e"> <text>If a resident who would qualify for home– and community–based waiver services under § 15–137 of this subtitle indicates an interest or preference for living in the community, the Department, or the Department’s designee, shall provide the resident with:</text> <level label="1"> <text>Additional information regarding home– and community–based services, including services available under a medical assistance waiver and their right to access services under § 15–137 of this subtitle; and</text> </level> <level label="2"> <text>Assistance in:</text> <level label="i"> <text>Completing any application forms or process, as needed; and</text> </level> <level label="ii"> <text>Moving from a nursing facility to a community–based setting appropriate to the resident’s needs and expressed wishes.</text> </level> </level> </level> <level label="f"> <level label="1"> <text>Subject to paragraph (3) of this subsection, employees or representatives of designated protection and advocacy systems agencies and of certified centers for independent living shall have reasonable and unaccompanied access to residents of public or private nursing facilities in the State that receive reimbursement under the Program for the purpose of providing information, training, and referral to programs and services addressing the needs of people with disabilities, including participation in programs that would enable individuals with disabilities to live outside the nursing facility.</text> </level> <level label="2"> <text>Employees or representatives of designated protection and advocacy systems agencies and of certified centers for independent living shall maintain the confidentiality of the residents and may not disclose the information provided to or by a resident, except with the express consent of the resident or the resident’s legal guardian or health care representative.</text> </level> <level label="3"> <text>Public or private nursing facilities may require the employees or representatives of designated protection and advocacy systems agencies and of certified centers for independent living to provide proof of their employment before authorizing the access required under paragraph (1) of this subsection.</text> </level> </level> <level label="g"> <text>On or before January 1 of each year, the Department, and the Department’s designee, shall report to the Governor and the General Assembly, in accordance with § 2–1257 of the State Government Article, on:</text> <level label="1"> <text>The Department’s efforts to promote home– and community–based services;</text> </level> <level label="2"> <text>The number of nursing facility residents referred or identified under subsections (c) and (d) of this section in the previous year;</text> </level> <level label="3"> <text>The number of nursing facility residents who transitioned from nursing facilities to home– and community–based waiver services;</text> </level> <level label="4"> <text>Any obstacles the Department confronted in assisting nursing home residents to make the transition from a nursing facility to a community–based residence; and</text> </level> <level label="5"> <text>The Department’s recommendations for removing the obstacles.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-136" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Department shall use existing resources to establish a toll free Maryland Pharmacy Access Hotline that:</text> <level label="1"> <text>Operates during regular business hours; and</text> </level> <level label="2"> <text>During nonbusiness hours allows callers to leave a message.</text> </level> </level> <level label="b"> <level label="1"> <text>The Department shall distribute to all Program recipients information about the Maryland Pharmacy Access Hotline.</text> </level> <level label="2"> <text>The information shall state clearly in easily readable print:</text> <level label="i"> <text>The toll free telephone number of the hotline; and</text> </level> <level label="ii"> <text>That the Program recipient should call the telephone number if the Program recipient is having problems getting necessary medicines.</text> </level> </level> </level> <level label="c"> <text>The Department shall notify all health care providers who participate in the Program about the Maryland Pharmacy Access Hotline.</text> </level> <level label="d"> <text>The Department shall:</text> <level label="1"> <text>Develop a methodology to track the number and type of calls received by the Maryland Pharmacy Access Hotline; and</text> </level> <level label="2"> <text>Provide a quarterly report to the Pharmacy and Therapeutics Committee that summarizes the number and type of calls received by the Maryland Pharmacy Access Hotline.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-137" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Department may not deny an individual access to a home– and community–based services waiver due to a lack of funding for waiver services if:</text> <level label="1"> <level label="i"> <text>The individual is living in a nursing facility at the time of the application for waiver services;</text> </level> <level label="ii"> <text>At least 30 consecutive days of the individual’s nursing facility stay are eligible to be paid for by the Program;</text> </level> <level label="iii"> <text>The individual meets all of the eligibility criteria for participation in the home– and community–based services waiver; and</text> </level> <level label="iv"> <text>The home– and community–based services provided to the individual would qualify for federal matching funds; or</text> </level> </level> <level label="2"> <level label="i"> <text>The individual is living at home or in the community at the time of the application for waiver services;</text> </level> <level label="ii"> <text>The individual received home– and community–based services through Community First Choice for at least 30 consecutive days;</text> </level> <level label="iii"> <text>The individual will be or has been terminated from participation in the Program on becoming entitled to or enrolled in Medicare Part A or enrolled in Medicare Part B;</text> </level> <level label="iv"> <text>The individual meets all of the eligibility criteria for participation in the home– and community–based services waiver within 6 months after the completion of the application; and</text> </level> <level label="v"> <text>The home– and community–based services provided to the individual would qualify for federal matching funds.</text> </level> </level> </level> <level label="b"> <text>Nothing in this section is intended to result in a reduction of federal funds available to the Department.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-138" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“EID Program” means the Employed Individuals with Disabilities Program operated under the Maryland Medical Assistance Program.</text> </level> <level label="3"> <text>“Independence account” means a financial account designated by a recipient of EID Program services:</text> <level label="i"> <text>That consists of earned income of a recipient or funds from other sources deposited by or for the recipient;</text> </level> <level label="ii"> <text>For which there is an upper limit of the total amount of earned income received by the recipient in an enrollment year and deposited into the account; and</text> </level> <level label="iii"> <text>For which there are no restrictions under the EID Program on how funds may be expended by the recipient.</text> </level> </level> </level> <level label="b"> <text>The Department shall provide health care services for individuals under the EID Program in accordance with this section.</text> </level> <level label="c"> <text>The Department shall:</text> <level label="1"> <text>Provide EID Program services to qualified applicants, including existing Program recipients, who are at least 16 years old;</text> </level> <level label="2"> <text>For initial applications to receive EID Program services, accept documents to verify income and resources that are dated up to 30 days before the date the application is received;</text> </level> <level label="3"> <text>Transition Program recipients who become eligible for the EID Program in a manner that is least disruptive to the recipient’s access to services;</text> </level> <level label="4"> <text>Ensure that the application process for the EID Program, to the extent authorized by the Centers for Medicare and Medicaid Services, provides maximum flexibility and plain language information for applicants, including:</text> <level label="i"> <text>Instructions for completing the application;</text> </level> <level label="ii"> <text>A description of documents the applicant must enclose with the application; and</text> </level> <level label="iii"> <text>Notice to the applicant of approval or denial of an application; and</text> </level> </level> <level label="5"> <text>Establish a premium contribution for EID Program services.</text> </level> </level> <level label="d"> <text>Subject to subsection (e) of this section, the Department may adopt regulations that develop specific eligibility criteria for participation in the EID Program.</text> </level> <level label="e"> <text>The Department may not:</text> <level label="1"> <text>Limit eligibility to receive EID Program services based on:</text> <level label="i"> <text>The earned or unearned income of the applicant or the applicant’s spouse;</text> </level> <level label="ii"> <text>Any assets or resources of the applicant’s or recipient’s spouse that are not joint assets for a recipient;</text> </level> <level label="iii"> <text>Any retirement account assets or resources for an applicant or a recipient; or</text> </level> <level label="iv"> <text>Any assets or resources in an independence account established for a recipient of EID Program services; or</text> </level> </level> <level label="2"> <text>Establish as a prerequisite for eligibility to receive EID Program services that an applicant apply for Social Security Disability Insurance benefits when the applicant does not receive the benefits and has earnings that are above the substantial gainful activity level established by the Social Security Administration.</text> </level> </level> <level label="f"> <text>The Department shall:</text> <level label="1"> <text>Meet with a State–based coalition of disability advocates twice a year to receive feedback on and discuss any needed changes to the EID Program; and</text> </level> <level label="2"> <text>Request feedback from the coalition before providing any information or materials on the EID Program to the public.</text> </level> </level> <level label="g"> <text>The Department shall apply to the Centers for Medicare and Medicaid Services for any amendments to the State plan, waivers, or other federal approvals necessary to implement the requirements of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-139" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>On or before December 1, 2003, the Department shall submit an application to the Centers for Medicare and Medicaid Services to amend the State Medical Assistance Program to allow the Department to receive federal matching funds for part of the nonroom–and–board portion of the costs of all eligible residential care that are related to the therapeutic components of care provided by State and local agencies through public or private providers to individuals under the age of 21 years.</text> </level> <level label="b"> <text>The application submitted by the Department under subsection (a) of this section:</text> <level label="1"> <text>Shall apply to a residential care placement providing therapeutic or rehabilitative services in addition to room and board services to an individual who is:</text> <level label="i"> <text>Under the age of 21 years; and</text> </level> <level label="ii"> <text>In the care or custody of, committed to, or voluntarily placed by any State or local agency in the State; and</text> </level> </level> <level label="2"> <text>Shall include placements in residential programs that have rates set by the interagency rates committee.</text> </level> </level> <level label="c"> <level label="1"> <text>For each fiscal year, the Governor may provide funds in the budget for the Children’s Cabinet Interagency Fund established under Title 8, Subtitle 5 of the Human Services Article, to be used by the Children’s Cabinet to create an interagency pool of funds to provide services to children with disabilities.</text> </level> <level label="2"> <text>The pool of interagency funds established under this subsection shall be used to fund the community–based services and community–based out–of–home placements needed by children with mental or developmental disabilities not in State custody, regardless of eligibility for the State Medical Assistance Program, if:</text> <level label="i"> <text>The child is in an out–of–home placement and has been recommended for discharge but the child’s family is unwilling or unable to have the child return home; or</text> </level> <level label="ii"> <text>The child remains in the home but the child’s family is unable to provide appropriate care for the child without additional services and the child is either at risk of requiring an out–of–home placement or the treating professionals have recommended an out–of–home placement.</text> </level> </level> </level> <level label="d"> <level label="1"> <text>The Governor’s Office for Children shall adopt regulations to carry out the provisions of subsection (c)(2) of this section.</text> </level> <level label="2"> <text>The regulations shall:</text> <level label="i"> <text>Include the criteria for eligibility and for prioritization of eligible children; and</text> </level> <level label="ii"> <text>Be developed with input from parents of a child with disabilities, groups representing families of potentially eligible children, advocacy organizations, the protection and advocacy system for persons with disabilities, providers, local agencies serving children with disabilities, and Subcabinet agencies.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>Nothing in this section is intended to result in the reduction of federal funds available to the Department of Human Services or the Department of Juvenile Services under Title IV–E of the Social Security Act for the room and board costs of eligible residential care.</text> </level> <level label="2"> <text>If, as a result of actions taken under this section, the federal matching funds available to the Department of Human Services and the Department of Juvenile Services under Title IV–E of the Social Security Act are reduced because the percentage of residential care costs allocated to Title IV–E is reduced, the Governor shall adjust the amount of funds provided under subsection (c) of this section to prevent any resulting loss to the Department of Human Services and the Department of Juvenile Services.</text> </level> <level label="3"> <text>The adjustment of funds under paragraph (2) of this subsection shall be based on determining the amount of Title IV–E reimbursement that would have been received by the Department of Human Services and the Department of Juvenile Services prior to October 1, 2003 using the current percentage of residential care costs that is allocated to Title IV–E.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-140" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Department shall apply to the Centers for Medicare and Medicaid Services for a State plan amendment to the Family Planning Program that:</text> <level label="1"> <text>Provides, subject to the limitations of the State budget, family planning services to an individual whose individual income is at or below 250% of the poverty level, as allowed by federal law;</text> </level> <level label="2"> <text>Does not impose age limitations on individuals who are able to receive family planning services;</text> </level> <level label="3"> <text>Establishes a presumptive eligibility process for enrollment in the Family Planning Program; and</text> </level> <level label="4"> <text>Exempts the Family Planning Program from federal coordination of benefits requirements if authorized under federal law.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-141.1" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “Collaborative Care Model” means an evidence–based approach for integrating somatic and behavioral health services in primary care settings that includes:</text> <level label="1"> <text>Care coordination and management;</text> </level> <level label="2"> <text>Regular, proactive outcome monitoring and treatment for outcome targets using standardized outcome measurement rating scales and electronic tools, such as patient tracking; and</text> </level> <level label="3"> <text>Regular systematic psychiatric and substance use disorder caseload reviews and consultation with a psychiatrist, an addiction medicine specialist, or any other behavioral health medicine specialist as allowed under federal regulations governing the model.</text> </level> </level> <level label="b"> <text>This section may not be construed to prohibit referrals from a primary care provider to a specialty behavioral health care provider.</text> </level> <level label="c"> <text>The Department shall implement and provide reimbursement for services provided in accordance with the Collaborative Care Model statewide in primary care settings that provide health care services to Program recipients.</text> </level> <level label="d"> <text>The Department may not impose a copayment, coinsurance, or deductible requirement for services provided in accordance with the Collaborative Care Model statewide in primary care settings that provide health care services to Program recipients.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-141.2" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Distant site” means a site at which the distant site health care provider is located at the time the health care service is provided through telehealth.</text> </level> <level label="3"> <text>“Distant site provider” means the health care provider who provides medically necessary services to a patient at an originating site from a different physical location than the location of the patient.</text> </level> <level label="4"> <text>“Health care provider” means:</text> <level label="i"> <text>A person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care in the ordinary course of business or practice of a profession or in an approved education or training program;</text> </level> <level label="ii"> <text>A mental health and substance use disorder program licensed in accordance with § 7.5–401 of this article;</text> </level> <level label="iii"> <text>A person licensed under Title 7, Subtitle 9 of this article to provide services to an individual with developmental disability or a recipient of individual support services; or</text> </level> <level label="iv"> <text>A provider as defined under § 16–201.4 of this article to provide services to an individual receiving long–term care services.</text> </level> </level> <level label="5"> <text>“Originating site” means the location of the Program recipient at the time the health care service is provided through telehealth.</text> </level> <level label="6"> <text>“Remote patient monitoring services” means the use of synchronous or asynchronous digital technologies that collect or monitor medical, patient–reported, and other forms of health care data for Program recipients at an originating site and electronically transmit that data to a distant site provider to enable the distant site provider to assess, diagnose, consult, treat, educate, provide care management, suggest self–management, or make recommendations regarding the Program recipient’s health care.</text> </level> <level label="7"> <level label="i"> <text>“Telehealth” means the delivery of medically necessary somatic, dental, or behavioral health services to a patient at an originating site by a distant site provider through the use of technology–assisted communication.</text> </level> <level label="ii"> <text>“Telehealth” includes:</text> <level label="1"> <text>Synchronous and asynchronous interactions;</text> </level> <level label="2"> <text>An audio–only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service; and</text> </level> <level label="3"> <text>Remote patient monitoring services.</text> </level> </level> <level label="iii"> <text>“Telehealth” does not include the provision of health care services solely through:</text> <level label="1"> <text>Except as provided in subparagraph (ii)2 of this paragraph, an audio–only telephone conversation;</text> </level> <level label="2"> <text>An e–mail message; or</text> </level> <level label="3"> <text>A facsimile transmission.</text> </level> </level> </level> </level> <level label="b"> <text>The Program shall:</text> <level label="1"> <text>Provide health care services appropriately delivered through telehealth to Program recipients regardless of the location of the Program recipient at the time telehealth services are provided; and</text> </level> <level label="2"> <text>Allow a distant site provider to provide health care services to a Program recipient from any location at which the health care services may be appropriately delivered through telehealth.</text> </level> </level> <level label="c"> <text>The services required to be provided under subsection (b) of this section shall include counseling and treatment for substance use disorders and mental health conditions.</text> </level> <level label="d"> <text>The Program may not:</text> <level label="1"> <text>Exclude from coverage a health care service solely because it is provided through telehealth and is not provided through an in–person consultation or contact between a health care provider and a patient; or</text> </level> <level label="2"> <text>Exclude from coverage a behavioral health care service provided to a Program recipient in person solely because the service may also be provided through telehealth.</text> </level> </level> <level label="e"> <text>The Program may undertake utilization review, including preauthorization, to determine the appropriateness of any health care service whether the service is delivered through an in–person consultation or through telehealth if the appropriateness of the health care service is determined in the same manner.</text> </level> <level label="f"> <text>The Program may not distinguish between Program recipients in rural or urban locations in providing coverage under the Program for health care services delivered through telehealth.</text> </level> <level label="g"> <level label="1"> <text>Subject to paragraph (3) of this subsection, the Program shall reimburse a health care provider for the diagnosis, consultation, and treatment of a Program recipient for a health care service covered by the Program that can be appropriately provided through telehealth.</text> </level> <level label="2"> <text>This subsection does not require the Program to reimburse a health care provider for a health care service delivered in person or through telehealth that is:</text> <level label="i"> <text>Not a covered health care service under the Program; or</text> </level> <level label="ii"> <text>Delivered by an out–of–network provider unless the health care service is a self–referred service authorized under the Program.</text> </level> </level> <level label="3"> <level label="i"> <text>When appropriately provided through telehealth, the Program shall provide reimbursement in accordance with paragraph (1) of this subsection on the same basis and the same rate as if the health care service were delivered by the health care provider in person.</text> </level> <level label="ii"> <text>The reimbursement required under subparagraph (i) of this paragraph does not include:</text> <level label="1"> <text>Clinic facility fees unless the health care service is provided by a health care provider not authorized to bill a professional fee separately for the health care service; or</text> </level> <level label="2"> <text>Any room and board fees.</text> </level> </level> </level> </level> <level label="h"> <level label="1"> <text>The Department may specify in regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients under this section.</text> </level> <level label="2"> <text>If the Department specifies by regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients under this subsection, the regulations shall include all types of health care providers that appropriately provide telehealth services.</text> </level> <level label="3"> <text>For the purpose of reimbursement and any fidelity standards established by the Department, a health care service provided through telehealth is equivalent to the same health care service when provided through an in–person consultation.</text> </level> </level> <level label="i"> <text>Subject to subsection (g)(2) of this section, the Program or a managed care organization that participates in the Program may not impose as a condition of reimbursement of a covered health care service delivered through telehealth that the health care service be provided by a third–party vendor designated by the Program.</text> </level> <level label="j"> <text>The Department may adopt regulations to carry out this section.</text> </level> <level label="k"> <text>The Department shall obtain any federal authority necessary to implement the requirements of this section, including applying to the Centers for Medicare and Medicaid Services for an amendment to any of the State’s § 1115 waivers or the State plan.</text> </level> <level label="l"> <text>This section may not be construed to supersede the authority of the Health Services Cost Review Commission to set the appropriate rates for hospitals, including setting the hospital facility fee for hospital–provided telehealth.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-141.3" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Certified violence prevention professional” means a prevention professional who meets the requirements of subsection (c) of this section.</text> </level> <level label="3"> <text>“Community violence” means intentional acts of interpersonal violence committed in public areas by individuals who are not family members or intimate partners of the victim.</text> </level> <level label="4"> <level label="i"> <text>“Community violence prevention services” means evidence–based, trauma–informed, supportive, and nonpsychotherapeutic services provided by a certified violence prevention professional, within or outside a clinical setting, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that an individual who is the victim of community violence will commit or promote violence.</text> </level> <level label="ii"> <text>“Community violence prevention services” includes peer support and counseling, mentorship, conflict mediation, crisis intervention, targeted case management referrals to certified or licensed health care professionals or social services providers, patient education, and screening services to victims of violence.</text> </level> </level> <level label="5"> <text>“Interpersonal violence” means the intentional use of physical force or power against another individual by an individual or a small group of individuals.</text> </level> <level label="6"> <text>“Prevention professional” has the meaning provided by the National Uniform Claim Committee, or its successor, under Code Number 405300000X.</text> </level> </level> <level label="b"> <text>The Program shall provide community violence prevention services to Program recipients who have:</text> <level label="1"> <level label="i"> <text>Been exposed to community violence; or</text> </level> <level label="ii"> <text>A personal history of injury sustained as a result of an act of community violence; and</text> </level> </level> <level label="2"> <text>Been referred by a certified or licensed health care provider or social services provider to a certified violence prevention professional to receive community violence prevention services after the provider makes a determination that the Program recipient is at an elevated risk of violent injury or retaliation resulting from another act of community violence.</text> </level> </level> <level label="c"> <text>A prevention professional seeking certification as a certified violence prevention professional shall:</text> <level label="1"> <text>Complete an accredited training and certification program for certified violence prevention professionals, approved in accordance with subsection (d) of this section; and</text> </level> <level label="2"> <text>Maintain the certification completed under item (1) of this subsection.</text> </level> </level> <level label="d"> <text>On or before January 1, 2023, the Department shall approve at least one accredited training and certification program for certified violence prevention professionals, which shall include:</text> <level label="1"> <text>At least 35 hours of initial training, addressing the following:</text> <level label="i"> <text>The profound effects of trauma and violence and the basics of trauma–informed care;</text> </level> <level label="ii"> <text>Community violence prevention strategies, including conflict mediation and retaliation prevention related to community violence;</text> </level> <level label="iii"> <text>Case management and advocacy practices; and</text> </level> <level label="iv"> <text>Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996; and</text> </level> </level> <level label="2"> <text>At least 6 hours of continuing education every 2 years.</text> </level> </level> <level label="e"> <text>An entity that employs or contracts with a certified violence prevention professional to provide community violence prevention services shall:</text> <level label="1"> <text>Maintain documentation that the certified violence prevention professional has met the requirements of subsection (c) of this section; and</text> </level> <level label="2"> <text>Ensure that the certified violence prevention professional is providing community violence prevention services in compliance with any applicable standard of care, rule, regulation, and State or federal law.</text> </level> </level> <level label="f"> <text>This section may not be construed to alter the scope of practice for any health care professional.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-141.4" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Birthing parent” means the individual giving birth and who is receiving doula services throughout the parent’s pregnancy, including the prenatal, labor, and postpartum periods.</text> </level> <level label="3"> <text>“Certified doula” means a trained nonmedical professional who provides continuous physical, emotional, and informational support to the birthing parent throughout the prenatal, labor, and postpartum periods who has received a certification to perform doula services approved by the Program.</text> </level> <level label="4"> <text>“Doula services” means continuous and nonclinical physical, emotional, and informational support, based on evidence–based practices and with respect for individual care needs, culture, and family traditions, to a birthing parent provided by a certified doula, including:</text> <level label="i"> <text>Education and guidance, supplementing the services of health care providers, on childbirth, coping skills for new parents, breastfeeding, infant feeding, infant soothing, and making informed decisions about childbirth and postpartum care;</text> </level> <level label="ii"> <text>Prenatal coaching;</text> </level> <level label="iii"> <text>Support for other individuals providing care for a birthing parent, including a birthing parent’s partner and family members; and</text> </level> <level label="iv"> <text>Facilitation of access to resources that can improve birth–related outcomes, including ongoing home visiting services, transportation, housing, the Special Supplemental Nutrition Program for Women, Infants and Children, the Supplemental Nutrition Assistance Program WIC, intimate partner violence resources, and alcohol, tobacco, and drug cessation.</text> </level> </level> <level label="5"> <text>“Home” means the residence of the birthing parent.</text> </level> <level label="6"> <text>“Labor and delivery” means the period during which the fetus, membranes, umbilical cord, and placenta are expelled from the uterus through vaginal birth or through surgical delivery by a cesarean section.</text> </level> <level label="7"> <text>“Medically indicated” means that a service or benefit meets the coverage requirements set by the Department.</text> </level> <level label="8"> <text>“Participating doula” means an individual who:</text> <level label="i"> <text>Meets the certification requirements as provided in subsection (d) of this section; and</text> </level> <level label="ii"> <text>Is authorized by the Department to provide health care services to a Program recipient.</text> </level> </level> <level label="9"> <text>“Provider” means an individual, an association, a partnership, or an incorporated or unincorporated group of doulas certified to provide doula services and who, through an appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number.</text> </level> </level> <level label="b"> <text>This section may not be construed to limit the authority of the Health Services Cost Review Commission to set the appropriate rates for hospital services.</text> </level> <level label="c"> <text>The Department shall:</text> <level label="1"> <text>Ensure that doulas providing care under the Program are participating doulas;</text> </level> <level label="2"> <text>Review participation in the Program of participating doulas and Program recipients; and</text> </level> <level label="3"> <text>Evaluate the effectiveness of doula services covered by the Program.</text> </level> </level> <level label="d"> <text>A provider shall:</text> <level label="1"> <text>Be certified by an organization approved by the Department; and</text> </level> <level label="2"> <text>Present proof to the Department of completion of the associated certification from at least one organization before providing doula services through the Program.</text> </level> </level> <level label="e"> <text>To participate in the Program, a provider shall:</text> <level label="1"> <text>Meet the requirements of COMAR 10.09.36.03 to participate in the Program;</text> </level> <level label="2"> <text>Maintain up–to–date certification as required by the Program; and</text> </level> <level label="3"> <text>Hold adequate liability insurance.</text> </level> </level> <level label="f"> <level label="1"> <text>The Program shall cover doula services that:</text> <level label="i"> <text>Are medically indicated;</text> </level> <level label="ii"> <text>Are provided during the prenatal, labor and delivery, or postpartum period of a birthing parent; and</text> </level> <level label="iii"> <text>If provided remotely, comply with the telehealth requirements in COMAR 10.09.49 and other relevant State and federal law.</text> </level> </level> <level label="2"> <text>Doula services covered by the Program are subject to any limitations adopted by the Department.</text> </level> </level> <level label="g"> <level label="1"> <text>A provider shall submit a request for payment in the format designated by the Program.</text> </level> <level label="2"> <text>The Program may return to the provider, before payment, any invoices that are not properly:</text> <level label="i"> <text>Signed;</text> </level> <level label="ii"> <text>Completed; or</text> </level> <level label="iii"> <text>Accompanied by properly completed forms required by the Program.</text> </level> </level> <level label="3"> <level label="i"> <text>A provider may charge the Program and the Program shall reimburse a provider.</text> </level> <level label="ii"> <text>A charge by a provider may be different from a customary charge by the provider for the same service.</text> </level> <level label="iii"> <text>The Program shall pay for covered services at a rate equal to the lesser of:</text> <level label="1"> <text>The customary charge the provider charges to the general public, unless the services are free to individuals not covered by the Program; or</text> </level> <level label="2"> <text>The Program’s fee schedule.</text> </level> </level> </level> </level> <level label="h"> <text>A managed care organization that participates in the Program shall provide medically indicated doula services to pregnant and postpartum enrollees.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-141.5" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>Subject to subsections (b) and (c) of this section, the Program shall provide remote ultrasound procedures and remote fetal nonstress tests using current procedural terminology codes if:</text> <level label="1"> <text>The patient is in a residence or a location other than the office of the patient’s provider; and</text> </level> <level label="2"> <text>The provider follows the same standard of care that the provider would follow when providing the services on–site.</text> </level> </level> <level label="b"> <text>The Program shall require that a provider offering a remote ultrasound procedure or remote fetal nonstress test use digital technology:</text> <level label="1"> <text>To collect any health data from the patient and electronically transmit the information in a secure manner to a health care provider in a different location for interpretation and recommendations;</text> </level> <level label="2"> <text>That is compliant with the federal Health Insurance Portability and Accountability Act of 1996; and</text> </level> <level label="3"> <text>That is approved by the federal Food and Drug Administration.</text> </level> </level> <level label="c"> <level label="1"> <text>The Program shall provide reimbursement for a remote fetal nonstress test in the same manner as an on–site fetal nonstress test.</text> </level> <level label="2"> <text>A remote fetal nonstress test for which reimbursement is provided under paragraph (1) of this subsection shall require the use of remote monitoring solutions that are cleared by the federal Food and Drug Administration for on–label use for monitoring:</text> <level label="i"> <text>Fetal heart rate;</text> </level> <level label="ii"> <text>Maternal heart rate; and</text> </level> <level label="iii"> <text>Uterine activity.</text> </level> </level> </level> <level label="d"> <text>The Program shall issue guidance for Program providers to carry out this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-141.6" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “eligible Program recipient” means a Program recipient who:</text> <level label="1"> <text>Is pregnant;</text> </level> <level label="2"> <text>Is postpartum; or</text> </level> <level label="3"> <text>Has been diagnosed with:</text> <level label="i"> <text>Chronic kidney disease;</text> </level> <level label="ii"> <text>Diabetes;</text> </level> <level label="iii"> <text>Heart disease; or</text> </level> <level label="iv"> <text>A cardiometabolic disease.</text> </level> </level> </level> <level label="b"> <text>The Program shall provide coverage for self–measured blood pressure monitoring for all eligible Program recipients, including:</text> <level label="1"> <text>The provision of validated home blood pressure monitors; and</text> </level> <level label="2"> <text>Reimbursement of health care provider and other staff time used for patient training, transmission of blood pressure data, interpretation of blood pressure readings and reporting, remote patient monitoring, and the delivery of co–interventions, including educational materials or classes.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-142" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “Fund” means the Fair Share Health Care Fund.</text> </level> <level label="b"> <text>There is a Fair Share Health Care Fund.</text> </level> <level label="c"> <text>The purpose of the Fund is to support the operations of the Program.</text> </level> <level label="d"> <level label="1"> <text>The Fund is a special, nonlapsing fund that is not subject to § 7-302 of the State Finance and Procurement Article.</text> </level> <level label="2"> <text>The Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.</text> </level> </level> <level label="e"> <text>The Fund consists of:</text> <level label="1"> <text>Any revenue received from payments made by employers under Title 8.5 of the Labor and Employment Article; and</text> </level> <level label="2"> <text>Any other money from any other source accepted for the benefit of the Fund.</text> </level> </level> <level label="f"> <text>The Fund may be used only to support the operations of the Program.</text> </level> <level label="g"> <level label="1"> <text>The Treasurer shall invest the money of the Fund in the same manner as other State money may be invested.</text> </level> <level label="2"> <text>Any investment earnings of the Fund shall be retained to the credit of the Fund.</text> </level> </level> <level label="h"> <text>The Fund shall be subject to an audit by the Office of Legislative Audits as provided for in § 2-1220 of the State Government Article.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-143" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Governor shall include in the budget bill for fiscal year 2008 at least $3,000,000 in General Fund State support for an immigrant health initiative to provide health care services for all legal immigrant children under the age of 18 years and pregnant women who meet program eligibility standards and arrived in the United States on or after August 22, 1996.</text> </section> <section article="ghg" article_name="Health - General" number="15-145" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “carrier” means:</text> <level label="1"> <text>A health insurer;</text> </level> <level label="2"> <text>A nonprofit health service plan;</text> </level> <level label="3"> <text>A health maintenance organization;</text> </level> <level label="4"> <text>A dental plan organization; and</text> </level> <level label="5"> <text>Any other person included as a third party in § 1902(a)(25)(A) of the Social Security Act, as amended by the federal Deficit Reduction Act of 2005.</text> </level> </level> <level label="b"> <level label="1"> <text>A carrier shall provide, at the request of the Department, information about individuals who are eligible for benefits under the Program or are Program recipients so that the Department may determine whether an individual, the spouse of an individual, or the dependent of an individual is receiving health care coverage from a carrier and the nature of that coverage.</text> </level> <level label="2"> <text>A carrier shall provide the information required under this subsection in a manner prescribed by the Department.</text> </level> </level> <level label="c"> <text>A carrier shall accept the Program’s right of recovery and the assignment to the Program of any right of an individual or other entity to payment from the carrier for an item or service for which payment has been made under the Program if the carrier has a legal obligation to make payment for the item or service.</text> </level> <level label="d"> <text>As a condition of doing business in the State, a carrier shall comply with the requirements set forth in § 42 U.S.C. 1396a(a)(25)(I)(i) through (iv).</text> </level> <level label="e"> <text>A carrier subject to this section may not reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or otherwise affect a health insurance policy or contract for a reason based wholly or partly on:</text> <level label="1"> <text>The eligibility of the individual for receiving benefits under the Program; or</text> </level> <level label="2"> <text>The receipt by an individual of benefits under the Program.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-146" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “home– and community–based waiver services” includes services provided under the Living at Home Waiver, the Older Adults Waiver, and the Medical Day Care Waiver.</text> </level> <level label="b"> <text>At least 90 days prior to making any change to medical eligibility for Program long–term care services, including nursing facility services, home– and community–based waiver services, and other services that require a nursing facility level of care, the Department shall provide a report to:</text> <level label="1"> <text>The Senate Finance Committee and the House Health Committee, in accordance with § 2–1257 of the State Government Article; and</text> </level> <level label="2"> <text>The Medicaid Advisory Committee.</text> </level> </level> <level label="c"> <text>The report required under subsection (b) of this section shall include:</text> <level label="1"> <text>The details of the intended change in medical eligibility;</text> </level> <level label="2"> <text>A description of how the intended change will affect current medical eligibility;</text> </level> <level label="3"> <text>The intended effective date of the change; and</text> </level> <level label="4"> <text>Whether the change will be pursued through departmental policy, by regulation, or by statute.</text> </level> </level> <level label="d"> <text>The Department shall discuss any report submitted to the Medicaid Advisory Committee under subsection (b) of this section at a meeting of the Medicaid Advisory Committee.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-147" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>Notwithstanding § 5–504 of the General Provisions Article, a former official or employee may not be considered to have participated significantly in a contract if the former official or employee: </text> <level label="1"> <text>Did not develop a request for proposals resulting in the contract;</text> </level> <level label="2"> <text>Did not participate in an evaluation committee or other State entity charged with selecting a contractor for the contract; and</text> </level> <level label="3"> <text>Participated only by providing support or other assistance as directed by a senior manager after contract award as part of the transition process from a State–run Medicaid Management Information System to a private contracted operation.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-148" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>Except for a drug or device for which the U.S. Food and Drug Administration has issued a black box warning, the Program may not apply a prior authorization requirement for a contraceptive drug or device that is:</text> <level label="1"> <level label="i"> <text>An intrauterine device; or</text> </level> <level label="ii"> <text>An implantable rod;</text> </level> </level> <level label="2"> <text>Approved by the U.S. Food and Drug Administration; and</text> </level> <level label="3"> <text>Obtained under a prescription written by an authorized prescriber.</text> </level> </level> <level label="b"> <text>The Program shall provide coverage for a single dispensing to an enrollee of a supply of prescription contraceptives for a 12–month period.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-149" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <level label="i"> <text>“Applied behavior analysis” means the design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce significant improvements in human behavior.</text> </level> <level label="ii"> <text>“Applied behavior analysis” includes the direct observations, measurement, and functional analysis of the relations between environment and behavior.</text> </level> </level> <level label="3"> <text>“Early and periodic screening, diagnosis, and treatment (EPSDT)” means the provision, to individuals under the age of 21 years, of preventive health care under 42 C.F.R. Part 441, Subpart B, as amended, and other health care services, diagnostic services, and treatment services that are necessary to correct or ameliorate defects, physical and mental illnesses, and conditions discovered by those screening services.</text> </level> </level> <level label="b"> <text>This section applies to EPSDT services available to Program recipients.</text> </level> <level label="c"> <level label="1"> <text>Subject to paragraph (2) of this subsection, the Department may not condition reimbursement of applied behavior analysis services provided to a Program recipient on the presence or availability of the parent or caregiver of the Program recipient in the setting where the applied behavior analysis services are provided to the Program recipient.</text> </level> <level label="2"> <text>Paragraph (1) of this subsection does not prohibit the Program from establishing reasonable standards for the involvement of a parent or caregiver, including requiring notification from the parent or caregiver of the decision of the parent or caregiver not to be present or available when the Program provides applied behavior analysis services to a Program recipient.</text> </level> </level> <level label="d"> <text>On or before December 1, 2021, the Department, in consultation with stakeholders, shall adopt regulations to implement the provisions of this section.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-150" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <level label="i"> <text>The Department shall develop plans to reduce the waitlists for the following waiver programs by 50%, beginning in fiscal year 2024:</text> <level label="1"> <text>The Community Pathways Waiver;</text> </level> <level label="2"> <text>The Community Supports Waiver;</text> </level> <level label="3"> <text>The Family Supports Waiver;</text> </level> <level label="4"> <text>The Brain Injury Waiver;</text> </level> <level label="5"> <text>The Home– and Community–Based Options Waiver;</text> </level> <level label="6"> <text>The Medical Day Care Services Waiver; and</text> </level> <level label="7"> <text>The Model Waiver for Medically Fragile Children.</text> </level> </level> <level label="ii"> <text>The Department shall develop a plan to reduce the registry for the Autism Waiver that includes conducting eligibility determinations of individuals on the registry and, beginning in fiscal year 2024, providing services to at least 50% of individuals determined eligible.</text> </level> </level> <level label="2"> <text>The plans required under this subsection shall include:</text> <level label="i"> <text>An assessment of whether each waiver program needs to recruit and retain new providers;</text> </level> <level label="ii"> <text>Measures to recruit and retain providers for each waiver program to expand the capacity of the programs;</text> </level> <level label="iii"> <text>Any changes in reimbursement rates needed to ensure provider capacity to provide services under the waiver programs;</text> </level> <level label="iv"> <text>The expected time frame for conducting eligibility determinations for the Autism Waiver;</text> </level> <level label="v"> <text>The expected time frame for reducing the waitlist or registry for each waiver program by 50%; and</text> </level> <level label="vi"> <text>The projected cost of the measures to be implemented under the plans.</text> </level> </level> <level label="3"> <text>Provisions of the plans relating to the Autism Waiver shall be developed in conjunction with the Maryland State Department of Education.</text> </level> </level> <level label="b"> <text>On or before January 1, 2023, the Department shall submit the plans to the Governor and, in accordance with § 2–1257 of the State Government Article, the chairs of the Senate Budget and Taxation Committee, the Senate Education, Health, and Environmental Affairs Committee, the Senate Finance Committee, the House Appropriations Committee, and the House Health and Government Operations Committee.</text> </level> <level label="c"> <level label="1"> <text>Beginning in fiscal year 2024, the Governor shall include in the annual budget bill sufficient funds to carry out this section.</text> </level> <level label="2"> <text>Funding included in the annual budget bill under paragraph (1) of this subsection may be allocated to programs identified under subsection (a) of this section for the purpose of hiring and retaining providers.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-151" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <level label="i"> <text>“Gender–affirming treatment” means any medically necessary treatment consistent with current clinical standards of care prescribed by a licensed health care provider for the treatment of a condition related to the individual’s gender identity.</text> </level> <level label="ii"> <text>“Gender–affirming treatment” includes:</text> <level label="1"> <text>Hormone therapy, hormone blockers, and puberty blockers;</text> </level> <level label="2"> <text>Hair alteration for the purposes of altering secondary sex characteristics and surgical site preparation;</text> </level> <level label="3"> <text>Alterations to voice, voice therapy, and voice lessons;</text> </level> <level label="4"> <text>Alterations to abdomen, chest, trunk, and buttocks;</text> </level> <level label="5"> <text>Alterations to the face and neck;</text> </level> <level label="6"> <text>Alterations to the genitals and gonads;</text> </level> <level label="7"> <text>Laser treatment for scars from gender–affirming treatment;</text> </level> <level label="8"> <text>Standard fertility preservation procedures, as set forth in § 15–810.1 of the Insurance Article;</text> </level> <level label="9"> <text>Revisions to previous treatments and reversal of treatments;</text> </level> <level label="10"> <text>Combinations of gender–affirming procedures; and</text> </level> <level label="11"> <text>Other treatments as prescribed to suppress the development of endogenous secondary sex characteristics, align the individual’s appearance or physical body with gender identity, and alleviate symptoms of clinically significant distress resulting from gender dysphoria.</text> </level> </level> <level label="iii"> <text>“Gender–affirming treatment” may include treatment described in the current clinical standards of care for gender–affirming treatment published by the World Professional Association for Transgender Health.</text> </level> </level> <level label="3"> <text>“Gender identity” has the meaning stated in § 20–101 of the State Government Article.</text> </level> </level> <level label="b"> <text>It is the intent of the General Assembly that the Program provide gender–affirming treatment to all Program recipients for whom gender–affirming treatment is medically necessary, including transgender, nonbinary, intersex, two–spirit, and other gender diverse individuals.</text> </level> <level label="c"> <level label="1"> <text>The Program shall provide coverage for medically necessary gender–affirming treatment in a nondiscriminatory manner.</text> </level> <level label="2"> <text>The gender–affirming treatment shall be assessed according to nondiscriminatory criteria that are consistent with current clinical standards of care.</text> </level> <level label="3"> <text>The Program may not deny or limit coverage for gender–affirming treatment when that treatment is:</text> <level label="i"> <text>Prescribed to a Program recipient because of, related to, or consistent with the recipient’s gender identity;</text> </level> <level label="ii"> <text>Medically necessary; and</text> </level> <level label="iii"> <text>Prescribed in accordance with current clinical standards of care.</text> </level> </level> <level label="4"> <text>The Program may not deny or limit coverage for gender–affirming treatment based on the Program recipient’s gender identity.</text> </level> <level label="5"> <text>The Program may not exclude gender–affirming treatment, including revisions to prior gender–affirming treatment, on the basis that the treatment is a cosmetic service.</text> </level> <level label="6"> <text>The Program may not establish a categorical exclusion for a particular gender–affirming treatment.</text> </level> <level label="7"> <text>The Program may not issue an adverse benefit determination denying or limiting access to gender–affirming treatment unless a health care provider with experience prescribing or delivering gender–affirming treatment has reviewed and confirmed the appropriateness of the adverse benefit determination.</text> </level> </level> <level label="d"> <level label="1"> <text>On or before December 1 each year, beginning in 2024, each managed care organization shall submit to the Department a report that includes, for each health care provider offering gender–affirming treatment with which the managed care organization has an active contract and that consents to the inclusion:</text> <level label="i"> <text>The name and location of the health care provider;</text> </level> <level label="ii"> <text>The types of gender–affirming treatment provided by the health care provider; and</text> </level> <level label="iii"> <text>Whether the health care provider consents to being publicly listed as part of the Department’s annual report required under paragraph (2) of this subsection.</text> </level> </level> <level label="2"> <level label="i"> <text>On or before January 1 each year, beginning in 2025, the Department shall compile an annual report on geographic access to gender–affirming treatment across the State.</text> </level> <level label="ii"> <text>The report shall include, for each health care provider offering gender–affirming treatment to Program recipients and whose consent to the inclusion is indicated in a report submitted under paragraph (1) of this subsection:</text> <level label="1"> <text>The name and location of the health care provider;</text> </level> <level label="2"> <text>The managed care organizations that have active contracts with the health care provider; and</text> </level> <level label="3"> <text>The types of gender–affirming treatment provided by the health care provider.</text> </level> </level> <level label="iii"> <text>The Department shall publish the report in a conspicuous manner on the Department’s website.</text> </level> </level> <level label="3"> <text>The Department and each managed care organization shall include the name, location, and types of services for each provider offering gender–affirming treatment in their provider directories.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-152" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>The Program shall provide coverage for services rendered to an enrollee by a licensed pharmacist acting within the pharmacist’s lawful scope of practice to the same extent as services rendered by any other licensed health care provider.</text> </level> <level label="b"> <text>Reimbursement for services provided under subsection (a) of this section may not be conditioned on whether the licensed pharmacist is:</text> <level label="1"> <text>Employed by a physician, pharmacy, or facility; or</text> </level> <level label="2"> <text>Acting under a physician’s orders.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-153" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>The Department shall annually evaluate reimbursement rates for dental services. </text> </section> <section article="ghg" article_name="Health - General" number="15-154" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>Unless the child’s family has requested that the child be removed, a child on the registry for the Autism Waiver shall remain on the registry if the child’s family relocates out of the State for uniformed services assignment.</text> </level> <level label="b"> <text>If a child on the registry for the Autism Waiver becomes eligible for services through the waiver while the child’s family is out of the State for uniformed services assignment, the child shall be eligible for services through the waiver if the family relocates to the State.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-155" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “prenatal risk assessment form” means a standardized form developed by the Department in accordance with the Centers for Medicare and Medicaid Services guidelines for use by a licensed health care provider to evaluate risk factors for the health of a pregnant patient.</text> </level> <level label="b"> <text>A provider who receives reimbursement from the Program for providing obstetric services to a patient shall complete a prenatal risk assessment form for the patient during the initial visit with the patient.</text> </level> <level label="c"> <text>After completing a prenatal risk assessment form in accordance with subsection (b) of this section, the provider shall submit the form to the local health department for the county in which the patient resides.</text> </level> <level label="d"> <text>On or before October 1 each year, each local health department shall submit to the Department a report that includes the number and type of referrals made to patients that were based on the information from the prenatal risk assessment form completed in accordance with subsection (b) of this section.</text> </level> <level label="e"> <text>The Department shall establish a process for a provider to submit a prenatal risk assessment form electronically.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-156" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “personal care aide” means an individual who provides personal assistance services through a residential service agency.</text> </level> <level label="b"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, this section applies only to personal assistance services provided through a residential service agency under Community First Choice, Community Options, Community Personal Assistance Services, and any other home– and community–based services administered by the Department.</text> </level> <level label="2"> <text>This section does not apply to personal care services provided through the Developmental Disabilities Administration.</text> </level> </level> <level label="c"> <level label="1"> <text>On or before September 1 each year, beginning in 2025, each residential service agency shall submit to the Maryland Department of Labor a report in the form and manner required by the Maryland Department of Labor.</text> </level> <level label="2"> <text>The annual report required under paragraph (1) of this subsection shall include:</text> <level label="i"> <text>Documentation of the residential service agency’s:</text> <level label="1"> <text>Average wage rate for personal care aides; and</text> </level> <level label="2"> <text>Highest and lowest wage rates for personal care aides; and</text> </level> </level> <level label="ii"> <text>Any other information that the Maryland Department of Labor determines appropriate.</text> </level> </level> <level label="3"> <text>The annual report required under paragraph (1) of this subsection shall be signed by an authorized representative of the residential service agency.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-157" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “Fund” means the Medicaid Primary Care Program Fund.</text> </level> <level label="b"> <text>There is a Medicaid Primary Care Program Fund in the Department.</text> </level> <level label="c"> <text>The purpose of the Fund is to serve as the foundation for advancing primary care in the State under the Advancing All–Payer Health Equity Approaches and Development (AHEAD) model.</text> </level> <level label="d"> <text>The Department shall administer the Fund.</text> </level> <level label="e"> <level label="1"> <text>The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="2"> <text>The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.</text> </level> </level> <level label="f"> <text>The Fund consists of:</text> <level label="1"> <text>Money appropriated in the State budget to the Fund;</text> </level> <level label="2"> <text>Hospital payments administered on a one–time basis, through a uniform and broad–based assessment via the Medicare savings component for calendar year 2023 by the Health Services Cost Review Commission; and</text> </level> <level label="3"> <text>Any other money from any other source accepted for the benefit of the Fund.</text> </level> </level> <level label="g"> <text>The Fund may be used to:</text> <level label="1"> <text>Implement a Medicaid primary care advanced payment model program as required under the AHEAD cooperative agreement; and</text> </level> <level label="2"> <text>Support primary care providers serving enrollees of the Medical Assistance Program through investments that include increased reimbursement for evaluation and management codes, care management fees to eligible practices, and quality incentives.</text> </level> </level> <level label="h"> <level label="1"> <text>The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested.</text> </level> <level label="2"> <text>Any interest earnings of the Fund shall be credited to the General Fund of the State.</text> </level> </level> <level label="i"> <text>Expenditures from the Fund may be made only in accordance with the State budget.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-158" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <level label="1"> <text>Subject to paragraph (2) of this subsection, the Program may not require prior authorization for a transfer to a special pediatric hospital.</text> </level> <level label="2"> <text>At the request of a special pediatric hospital, the Program and the Maryland Children’s Health Program shall provide a prior authorization determination regarding a transfer to a special pediatric hospital within 3 business days after the request is received.</text> </level> </level> <level label="b"> <level label="1"> <text>On or before December 31, 2026, the Department shall adopt regulations establishing a retrospective review process for special pediatric hospitals.</text> </level> <level label="2"> <text>The regulations adopted under paragraph (1) of this subsection shall:</text> <level label="i"> <text>Provide for a peer–to–peer reconsideration of a medical necessity determination made by the Department or its agent on request of a pediatric specialty hospital;</text> </level> <level label="ii"> <text>Provide for retrospective review of any medical necessity determination issued by the Department or its agent denying:</text> <level label="1"> <text>Admission to a special pediatric hospital on or after January 1, 2025; or</text> </level> <level label="2"> <text>Reimbursement for inpatient services or outpatient services provided by a special pediatric hospital on or after January 1, 2025;</text> </level> </level> <level label="iii"> <text>Comply with Title 10, Subtitle 2 of the State Government Article; and</text> </level> <level label="iv"> <text>Provide that the retrospective review process be conducted by a licensed physician.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-159" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <text>If the Program covers the delivery of anesthesia for a procedure for which a licensed medical professional issues an order, the Program:</text> <level label="1"> <text>Shall provide coverage for:</text> <level label="i"> <text>The delivery of anesthesia for the entire duration of the procedure; and</text> </level> <level label="ii"> <text>Medical care related to the delivery of anesthesia for the procedure that is provided immediately before and after the procedure; and</text> </level> </level> <level label="2"> <text>May not establish, implement, or enforce a policy, practice, or procedure that places time limitations on the delivery of anesthesia.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-160" effective_note="EFFECTIVE UNTIL SEPTEMBER 30, 2029 PER CHAPTER 166 OF 2026" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “database” means the employment training and opportunity database developed and maintained under subsection (b) of this section.</text> </level> <level label="b"> <level label="1"> <text>The Department shall develop and maintain an employment training and opportunity database.</text> </level> <level label="2"> <text>The purpose of the database is to provide individuals in the State with assistance in finding employment training and other opportunities that may enable the individuals to become eligible and maintain eligibility for:</text> <level label="i"> <text>The Program; and</text> </level> <level label="ii"> <text>The Supplemental Nutrition Assistance Program.</text> </level> </level> <level label="3"> <text>In developing and maintaining the database, the Department shall coordinate with the following entities:</text> <level label="i"> <text>The Maryland Department of Labor;</text> </level> <level label="ii"> <text>The Department of Human Services;</text> </level> <level label="iii"> <text>The Department of Service and Civic Innovation;</text> </level> <level label="iv"> <text>The Maryland Chamber of Commerce;</text> </level> <level label="v"> <text>Labor unions;</text> </level> <level label="vi"> <text>Trade associations;</text> </level> <level label="vii"> <text>Educational institutions;</text> </level> <level label="viii"> <text>Local workforce development boards; and</text> </level> <level label="ix"> <text>Any other entity that the Department determines appropriate.</text> </level> </level> </level> <level label="c"> <text>The database shall include:</text> <level label="1"> <text>Vocational, workforce training, and job placement programs available in the State;</text> </level> <level label="2"> <text>Information regarding how to apply for a vocational, workforce training, or job placement program included in the database under item (1) of this subsection; and</text> </level> <level label="3"> <text>A mechanism that allows an individual to directly contact the vocational, workforce training, or job placement program in which the individual is interested.</text> </level> </level> <level label="d"> <text>The Department shall:</text> <level label="1"> <text>Make the database available to the public on a dedicated page on the Department’s website;</text> </level> <level label="2"> <text>Assist individuals in enrolling in vocational, workforce training, and job placement programs listed in the database; and</text> </level> <level label="3"> <text>Update the database at least every 30 days.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-161" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs"> <level label="a"> <text>In this section, “comprehensive coverage for the treatment of obesity” includes coverage for intensive behavioral therapy, bariatric surgery, and any medication approved by the federal Food and Drug Administration with an indication for chronic weight management in patients with obesity.</text> </level> <level label="b"> <text>The Program may provide comprehensive coverage for the treatment of obesity.</text> </level> <level label="c"> <text>The Program may undertake utilization management to determine the medical necessity and appropriateness for treatment of obesity under this section if the determinations are made in the same manner as determinations are made for the treatment of any other illness, condition, or disorder covered by the Program.</text> </level> <level label="d"> <text>If the Department elects to provide comprehensive coverage for the treatment of obesity under this section, the Department shall provide notice to Program recipients.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-301" title_number="15" title_name="Assistance Programs" subtitle_number="3" subtitle_name="Maryland Children's Health Program"> <level label="a"> <text>There is a Maryland Children’s Health Program.</text> </level> <level label="b"> <text>The Maryland Children’s Health Program shall provide, subject to the limitations of the State budget and any other requirements imposed by the State and as permitted by federal law or waiver, comprehensive medical care and other health care services to an individual who:</text> <level label="1"> <text>Does not qualify for coverage under § 15–103(b) of this title; and</text> </level> <level label="2"> <text>Has a family income at or below 300 percent of the federal poverty guidelines and who is under the age of 19 years.</text> </level> </level> <level label="c"> <level label="1"> <text>The Department shall provide eligible individuals and health care providers with an accurate directory or other listing of all available providers:</text> <level label="i"> <text>In written form, made available upon request; and</text> </level> <level label="ii"> <text>On an Internet database.</text> </level> </level> <level label="2"> <text>The Department shall update the Internet database at least every 30 days.</text> </level> <level label="3"> <text>The written directory shall include a conspicuous reference to the Internet database.</text> </level> </level> <level label="d"> <text>The Department shall develop a process for providing information about the availability of the State’s earned income tax credit established under § 10–704 of the Tax – General Article to each Program enrollee or potential Program enrollee when providing information about the Program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-302" title_number="15" title_name="Assistance Programs" subtitle_number="3" subtitle_name="Maryland Children's Health Program"> <level label="a"> <level label="1"> <text>The Department shall monitor applications to determine whether employers and employees have voluntarily terminated coverage under an employer sponsored health benefit plan that included dependent coverage in order to participate in the Maryland Children’s Health Program established under § 15–301 of this subtitle.</text> </level> <level label="2"> <text>The Department, in particular, shall review applications of individuals who qualified for Program benefits under the Maryland Children’s Health Program established under § 15–301 of this subtitle.</text> </level> </level> <level label="b"> <level label="1"> <text>An application may be disapproved if it is determined that an individual under the age of 19 years to be covered under the Maryland Children’s Health Program, for whom the application was submitted, was covered by an employer sponsored health benefit plan with dependent coverage which was voluntarily terminated within 6 months preceding the date of the application.</text> </level> <level label="2"> <text>In determining whether an applicant has voluntarily terminated coverage under an employer sponsored health benefit plan for purposes of paragraph (1) of this subsection, a voluntary termination may not be construed to include:</text> <level label="i"> <text>Loss of employment due to factors other than voluntary termination;</text> </level> <level label="ii"> <text>Change to a new employer that does not provide an option for dependent coverage;</text> </level> <level label="iii"> <text>Change of address so that no employer sponsored health benefit plan is available;</text> </level> <level label="iv"> <text>Discontinuation of health benefits to all dependents of employees of the applicant’s employer; or</text> </level> <level label="v"> <text>Expiration of the applicant’s continuation of coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-303" title_number="15" title_name="Assistance Programs" subtitle_number="3" subtitle_name="Maryland Children's Health Program"> <level label="a"> <level label="1"> <text>The Department shall be responsible for enrolling program recipients in managed care organizations under the Maryland Children’s Health Program established under § 15–301 of this subtitle.</text> </level> <level label="2"> <text>The Department may contract with an entity to perform any part or all of its enrollment responsibilities under paragraph (1) of this subsection.</text> </level> <level label="3"> <text>The Department or its enrollment contractor, to the extent feasible in its marketing, outreach, and enrollment programs, shall hire individuals receiving assistance under the Family Investment Program established under Title 5, Subtitle 3 of the Human Services Article.</text> </level> </level> <level label="b"> <level label="1"> <text>To the extent allowed under federal law and regulations, the Secretary shall implement expedited eligibility for any individual who applies through the local health department for the Maryland Children’s Health Program under § 15–301 of this subtitle, including any individual with associated food stamp, cash assistance, or medical assistance cases.</text> </level> <level label="2"> <text>The Secretary shall designate organizations that may:</text> <level label="i"> <text>Assist individuals in the application process; and</text> </level> <level label="ii"> <text>Perform other outreach functions.</text> </level> </level> <level label="3"> <text>In designating the organizations under paragraph (2) of this subsection, the Secretary shall ensure the inclusion of statewide and local organizations that provide services to children of all ages in each region of the State, and shall provide such organizations with:</text> <level label="i"> <text>Forms that are necessary for parents, guardians, and other individuals to submit applications to the Maryland Children’s Health Program on behalf of a child; and</text> </level> <level label="ii"> <text>Information on how to assist parents, guardians, and other individuals in completing and filing such applications.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-304" title_number="15" title_name="Assistance Programs" subtitle_number="3" subtitle_name="Maryland Children's Health Program"> <level label="a"> <level label="1"> <text>For purposes of increasing the number of eligible individuals who enroll in the Maryland Children’s Health Program established under § 15–301 of this subtitle, the Department shall develop and implement a school–based outreach program.</text> </level> <level label="2"> <text>As appropriate to carry out its responsibilities under paragraph (1) of this subsection, the Department may enter into contracts with county boards of education to provide information at public schools on the Maryland Children’s Health Program established under § 15–301 of this subtitle.</text> </level> </level> <level label="b"> <level label="1"> <text>For purposes of this subsection, “community–based organization” includes child care centers, schools, and school–based health clinics.</text> </level> <level label="2"> <text>In addition to the school–based outreach program established under subsection (a) of this section, the Department, in consultation with the Maryland Medicaid Advisory Committee established under § 15–103.2 of this title, shall develop mechanisms for outreach for the program with a special emphasis on identifying children who may be eligible for program benefits under the Maryland Children’s Health Program established under § 15–301 of this subtitle.</text> </level> <level label="3"> <text>From the mechanisms to be developed for outreach under paragraph (2) of this subsection, one mechanism shall include the development and dissemination of mail–in applications and appropriate outreach materials through community–based organizations, community–based providers, the Office of the State Comptroller, the Departments of Human Services and Health, county boards of education, and any other appropriate State agency or unit the Department considers appropriate.</text> </level> </level> <level label="c"> <level label="1"> <text>The Department shall collaborate with the Office of the Comptroller or the Office of the State Treasurer to:</text> <level label="i"> <text>Form a one–sentence statement advising that individuals who cannot afford health insurance may be eligible to enroll in the Maryland Children’s Health Program; and</text> </level> <level label="ii"> <text>Print the statement formed under item (i) of this paragraph:</text> <level label="1"> <text>On each State–issued tax refund check stub;</text> </level> <level label="2"> <text>Once each pay quarter, on each State–issued employee paycheck stub; and</text> </level> <level label="3"> <text>On each State–issued child support payment check stub.</text> </level> </level> </level> <level label="2"> <text>The statement shall contain a telephone number or other contact information that an individual may use to receive more information on eligibility for the Maryland Children’s Health Program.</text> </level> <level label="3"> <text>The statement may be altered by the Department in collaboration with the Office of the Comptroller or the Office of the State Treasurer to:</text> <level label="i"> <text>Provide the most current information;</text> </level> <level label="ii"> <text>Fit within the space constraints of the different types of checks listed in paragraph (1)(ii) of this subsection; or</text> </level> <level label="iii"> <text>Combine it with the statement required under § 15–102.1(c) of this title, if appropriate.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-305" title_number="15" title_name="Assistance Programs" subtitle_number="3" subtitle_name="Maryland Children's Health Program"> <level label="a"> <text>On or before January 1, 2025, subject to the limitations of the State budget and as permitted by federal law, the Department:</text> <level label="1"> <text>Shall establish an Express Lane Eligibility Program to enroll individuals in the Program and the Maryland Children’s Health Program based on eligibility findings by the Supplemental Nutrition Assistance Program;</text> </level> <level label="2"> <text>May not consider any other income or eligibility requirements;</text> </level> <level label="3"> <text>To the extent that a waiver is needed to maximize the number of State residents who may qualify for the Express Lane Eligibility Program, shall apply to the Centers for Medicare and Medicaid Services for one or more waivers under § 1115 of the federal Social Security Act to implement the Express Lane Eligibility Program; and</text> </level> <level label="4"> <text>Subject to subsection (b) of this section, shall make all reasonable efforts to expedite enrollment of eligible individuals in the Express Lane Eligibility Program.</text> </level> </level> <level label="b"> <text>The Department may propose or implement the use of Express Lane Eligibility for renewals before proposing or implementing the use of Express Lane Eligibility for initial enrollment.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-306" title_number="15" title_name="Assistance Programs" subtitle_number="3" subtitle_name="Maryland Children's Health Program"> <text>Subject to the limitations of the State budget and as permitted by federal law or waiver, the Maryland Children’s Health Program may provide guaranteed eligibility for each enrollee for up to 6 months unless an enrollee obtains health insurance through another source.</text> </section> <section article="ghg" article_name="Health - General" number="15-307" title_number="15" title_name="Assistance Programs" subtitle_number="3" subtitle_name="Maryland Children's Health Program"> <level label="a"> <text>Except for a drug or device for which the U.S. Food and Drug Administration has issued a black box warning, the Maryland Children’s Health Program may not apply a prior authorization requirement for a contraceptive drug or device that is:</text> <level label="1"> <level label="i"> <text>An intrauterine device; or</text> </level> <level label="ii"> <text>An implantable rod;</text> </level> </level> <level label="2"> <text>Approved by the U.S. Food and Drug Administration; and</text> </level> <level label="3"> <text>Obtained under a prescription written by an authorized prescriber.</text> </level> </level> <level label="b"> <text>The Maryland Children’s Health Program shall provide coverage for a single dispensing to an enrollee of a supply of prescription contraceptives for a 12–month period.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-308" title_number="15" title_name="Assistance Programs" subtitle_number="3" subtitle_name="Maryland Children's Health Program"> <level label="a"> <text>The Maryland Children’s Health Program shall provide coverage for services rendered to an enrollee by a licensed pharmacist acting within the pharmacist’s lawful scope of practice to the same extent as services rendered by any other licensed health care provider.</text> </level> <level label="b"> <text>Reimbursement for services provided under subsection (a) of this section may not be conditioned on whether the licensed pharmacist is:</text> <level label="1"> <text>Employed by a physician, pharmacy, or facility; or</text> </level> <level label="2"> <text>Acting under a physician’s orders.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-309" title_number="15" title_name="Assistance Programs" subtitle_number="3" subtitle_name="Maryland Children's Health Program"> <text>The Maryland Children’s Health Program may not require prior authorization for a transfer to a special pediatric hospital.</text> </section> <section article="ghg" article_name="Health - General" number="15-401" title_number="15" title_name="Assistance Programs" subtitle_number="4" subtitle_name="Qualified State Long-Term Care Insurance Partnership"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Commissioner” means the Insurance Commissioner.</text> </level> <level label="c"> <text>“Program” means the Qualified State Long–Term Care Insurance Partnership.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-402" title_number="15" title_name="Assistance Programs" subtitle_number="4" subtitle_name="Qualified State Long-Term Care Insurance Partnership"> <level label="a"> <text>There is a Qualified State Long–Term Care Insurance Partnership.</text> </level> <level label="b"> <text>The purposes of the Program are to:</text> <level label="1"> <text>Provide incentives for individuals to insure against the costs of providing for their long–term care needs;</text> </level> <level label="2"> <text>Provide mechanisms for individuals to qualify for coverage of the costs of their long–term care needs under the medical assistance program without first being required to substantially exhaust all their resources;</text> </level> <level label="3"> <text>Assist in developing methods for increasing access to and the affordability of a long–term care policy; and</text> </level> <level label="4"> <text>Alleviate the financial burden on the State’s medical assistance program by encouraging pursuit of private initiatives.</text> </level> </level> <level label="c"> <text>The Program shall:</text> <level label="1"> <text>Be administered by:</text> <level label="i"> <text>The Department; and</text> </level> <level label="ii"> <text>The Commissioner;</text> </level> </level> <level label="2"> <text>Provide for the financing of long–term care services by:</text> <level label="i"> <text>Private insurance; and</text> </level> <level label="ii"> <text>State medical assistance; and</text> </level> </level> <level label="3"> <text>Comply with the requirements of § 1917(b) of the Social Security Act and any applicable federal guidelines.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-403" title_number="15" title_name="Assistance Programs" subtitle_number="4" subtitle_name="Qualified State Long-Term Care Insurance Partnership"> <level label="a"> <text>To be eligible for the Program, an individual must:</text> <level label="1"> <text>Be covered by a long–term care policy that is approved for the Program by the Commissioner under § 15–404 of this subtitle; and</text> </level> <level label="2"> <text>Satisfy any other requirement for eligibility established by the Department.</text> </level> </level> <level label="b"> <text>Program eligibility may not be denied under this section for policy benefits that are not available or appropriate for treating the insured’s condition.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-404" title_number="15" title_name="Assistance Programs" subtitle_number="4" subtitle_name="Qualified State Long-Term Care Insurance Partnership"> <text>To qualify under the Program, a long–term care policy shall:</text> <level label="1"> <text>Satisfy the requirements of § 1917(b) of the Social Security Act and any applicable federal guidelines;</text> </level> <level label="2"> <text>Satisfy the requirements of Title 18 of the Insurance Article; and</text> </level> <level label="3"> <text>Alert the purchaser to the availability of consumer information and public education provided by the Commissioner under § 15–406 of this subtitle in accordance with any applicable federal guidelines.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-405" title_number="15" title_name="Assistance Programs" subtitle_number="4" subtitle_name="Qualified State Long-Term Care Insurance Partnership"> <text>In determining eligibility for medical assistance, an amount of resources equal to the amount of benefits paid under the long–term care policy shall be excluded from the Department’s calculation of the individual’s resources.</text> </section> <section article="ghg" article_name="Health - General" number="15-406" title_number="15" title_name="Assistance Programs" subtitle_number="4" subtitle_name="Qualified State Long-Term Care Insurance Partnership"> <text>The Commissioner, through the Consumer Education and Advocacy Program, shall undertake measures to educate the public as to:</text> <level label="1"> <text>The need for long–term care;</text> </level> <level label="2"> <text>Mechanisms for financing long–term care;</text> </level> <level label="3"> <text>The availability of long–term care insurance; and</text> </level> <level label="4"> <text>The asset protection provided under this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-407" title_number="15" title_name="Assistance Programs" subtitle_number="4" subtitle_name="Qualified State Long-Term Care Insurance Partnership"> <text>The Department and the Commissioner shall jointly:</text> <level label="1"> <text>Adopt regulations necessary to carry out the provisions of this subtitle consistent with § 1917(b) of the Social Security Act and any applicable federal guidelines; and</text> </level> <level label="2"> <text>Beginning January 1, 2009, and on or before January 1 of each year thereafter, report to the General Assembly, in accordance with § 2–1257 of the State Government Article on:</text> <level label="i"> <text>The effectiveness of the Program;</text> </level> <level label="ii"> <text>The impact of the Program on State expenditures for medical assistance;</text> </level> <level label="iii"> <text>The number of enrollees in the Program; and</text> </level> <level label="iv"> <text>The number of long–term care policies offered in the State under the Program.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-408" title_number="15" title_name="Assistance Programs" subtitle_number="4" subtitle_name="Qualified State Long-Term Care Insurance Partnership"> <text>The Department shall develop a process for providing information about the availability of the State’s earned income tax credit established under § 10–704 of the Tax – General Article to each Program enrollee or potential Program enrollee when providing information about the Program.</text> </section> <section article="ghg" article_name="Health - General" number="15-501" title_number="15" title_name="Assistance Programs" subtitle_number="5" subtitle_name="Evaluation and Planning Services"> <level label="a"> <text>An individual who is eligible for medical assistance at the time of application for admission to a licensed nursing home or would become eligible within 6 months following admission shall be provided a comprehensive face–to–face evaluation prior to admission, at no charge to the individual. The Department, under the Maryland Medical Assistance Program, shall pay for the evaluation. The evaluation shall include an assessment of an individual’s health, social and functional status, and recommendations for available services that could appropriately substitute for nursing home care. The evaluation is advisory only and may not serve as the basis for any action, including denial or commencement of benefits, that restricts the freedom of any individual to select from among any of the available services, including nursing home care, for which the individual is found to be medically eligible. Prior to beginning the evaluation process and annually thereafter, the Department shall prepare and publish an inventory of available services for use in the evaluation and shall provide this information for assistance to the individual upon completion of the evaluation.</text> </level> <level label="b"> <text>The Department shall adopt rules and regulations to carry out the provisions of this section.</text> </level> <level label="c"> <text>This section may not be construed to require a hospital or physician to detain a patient for an evaluation beyond the appropriate date of discharge.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-601" title_number="15" title_name="Assistance Programs" subtitle_number="6" subtitle_name="Prescription Drug Repository Program"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Board” means the State Board of Pharmacy.</text> </level> <level label="c"> <text>“Dispense” means to provide:</text> <level label="1"> <text>A prescription drug or medical supply in accordance with a prescription; or</text> </level> <level label="2"> <text>An over–the–counter drug or medical supply.</text> </level> </level> <level label="d"> <text>“Drop–off site” means a pharmacy, other health care facility, or other entity participating in a drug donation or repository program and designated by the Board that:</text> <level label="1"> <text>Has voluntarily agreed to accept donated prescription drugs, over–the–counter drugs, or medical supplies;</text> </level> <level label="2"> <text>Is located within the State or in another state; and</text> </level> <level label="3"> <text>Does not have a final disciplinary order issued against it by a health occupations board.</text> </level> </level> <level label="e"> <text>“Eligible patient” means an individual who, through self–attestation, is indigent, uninsured, underinsured, or enrolled in a public health benefits program.</text> </level> <level label="f"> <text>“Program” means the Prescription Drug Repository Program.</text> </level> <level label="g"> <text>“Repository” means a licensed pharmacy that:</text> <level label="1"> <text>If the licensed pharmacy is located in the State, does not have a final disciplinary order issued against it by the Board of Pharmacy;</text> </level> <level label="2"> <text>Has voluntarily agreed to participate in the Program;</text> </level> <level label="3"> <text>Is located in the State or in another state; and</text> </level> <level label="4"> <text>Has been approved by the Board to:</text> <level label="i"> <text>Accept donated prescription drugs, over–the–counter drugs, or medical supplies from a designated drop–off site;</text> </level> <level label="ii"> <text>Dispense the donated prescription drugs, over–the–counter drugs, or medical supplies to eligible patients; or</text> </level> <level label="iii"> <text>Dispose of prescription drugs, over–the–counter drugs, or medical supplies not accepted for dispensing to eligible patients.</text> </level> </level> </level> <level label="h"> <text>“Tamper–evident packaging” means a packaging system that:</text> <level label="1"> <text>May involve an immediate–container and closure system, secondary–container or carton system, tertiary–container system, or other combination of systems intended to provide a visual indication of package integrity;</text> </level> <level label="2"> <text>May contain unit–dose or multi–dose contents; and</text> </level> <level label="3"> <text>Has one or more indicators or barriers to entry that:</text> <level label="i"> <text>If breached or missing, can reasonably be expected to provide visible evidence to consumers that tampering has occurred; and</text> </level> <level label="ii"> <text>If handled in a reasonable manner during manufacture, distribution, or retail display, is designed to remain intact.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-602" title_number="15" title_name="Assistance Programs" subtitle_number="6" subtitle_name="Prescription Drug Repository Program"> <level label="a"> <text>There is a Prescription Drug Repository Program regulated by the Board.</text> </level> <level label="b"> <text>The purpose of the Program is to:</text> <level label="1"> <text>Accept prescription drugs, over–the–counter drugs, and medical supplies donated for the purpose of dispensing to eligible patients; and</text> </level> <level label="2"> <text>Accept prescription drugs, over–the–counter drugs, and medical supplies returned to a pharmacy for the purpose of proper disposal.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-603" title_number="15" title_name="Assistance Programs" subtitle_number="6" subtitle_name="Prescription Drug Repository Program"> <level label="a"> <text>Except as provided in subsection (b) of this section, the Program may accept for the purpose of dispensing only:</text> <level label="1"> <text>Prescription drugs and over–the–counter drugs in their original unopened, sealed, and tamper–evident packaging, including drugs that have been packaged by a manufacturer or have been repackaged by an entity authorized to repackage drugs in the state in which the entity is located; and</text> </level> <level label="2"> <text>Medical supplies in their original unopened and sealed packaging.</text> </level> </level> <level label="b"> <text>The Program may accept and dispense prescription drugs and over–the–counter drugs packaged in single unit doses when the outside packaging is opened if the single unit dose packaging is undisturbed.</text> </level> <level label="c"> <level label="1"> <text>The Program may not accept prescription drugs, over–the–counter drugs, or medical supplies for dispensing that:</text> <level label="i"> <text>Except as provided in paragraph (2) of this subsection, bear an expiration date that is less than 90 days from the date the drug is donated;</text> </level> <level label="ii"> <text>May be adulterated, according to the standards of § 21–216 of this article; or</text> </level> <level label="iii"> <text>Belong to a category of unacceptable drugs established under § 15–608(b)(1) of this subtitle.</text> </level> </level> <level label="2"> <level label="i"> <text>The Program may accept prescription drugs and over–the–counter drugs that bear an expiration date that is less than 90 days from the date the drug is donated if the prescription drug or over–the–counter drug is in high demand.</text> </level> <level label="ii"> <text>If the Program accepts a prescription drug or over–the–counter drug under subparagraph (i) of this paragraph, the Program may not dispense the prescription drug or over–the–counter drug if the expiration date occurs during the time period for which the prescription drug or over–the–counter drug is prescribed.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-604" title_number="15" title_name="Assistance Programs" subtitle_number="6" subtitle_name="Prescription Drug Repository Program"> <level label="a"> <level label="1"> <text>Any person may donate prescription drugs, over–the–counter drugs, or medical supplies to the Program.</text> </level> <level label="2"> <text>The Program may receive donated prescription drugs, over–the–counter drugs, or medical supplies from any person.</text> </level> </level> <level label="b"> <text>Prescription drugs, over–the–counter drugs, or medical supplies may be donated only to a drop–off site designated for that purpose by the Board.</text> </level> <level label="c"> <text>A drop–off site located in the State shall:</text> <level label="1"> <text>Require a donor to complete and sign a donor form releasing the prescription drugs, over–the–counter drugs, or medical supplies to the Program;</text> </level> <level label="2"> <text>Store donated prescription drugs, over–the–counter drugs, and medical supplies in a secure location used exclusively for the Program; and</text> </level> <level label="3"> <text>Forward, at the cost of the designated drop–off site, all donated prescription drugs, over–the–counter drugs, and medical supplies to a repository.</text> </level> </level> <level label="d"> <text>A drop–off site located in the State may not:</text> <level label="1"> <text>Dispense donated prescription drugs, over–the–counter drugs, or medical supplies;</text> </level> <level label="2"> <text>Resell prescription drugs, over–the–counter drugs, or medical supplies donated to the Program; or</text> </level> <level label="3"> <text>Charge a fee for accepting a donation.</text> </level> </level> <level label="e"> <text>Consistent with its approval by the Board, an entity located in another state:</text> <level label="1"> <text>May participate in the Program as a drop–off site; and</text> </level> <level label="2"> <text>May accept donated prescription drugs, over–the–counter drugs, and medical supplies from a person, unless otherwise prohibited by federal law or the laws of the state in which the entity is located.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-605" title_number="15" title_name="Assistance Programs" subtitle_number="6" subtitle_name="Prescription Drug Repository Program"> <level label="a"> <text>The Board may approve a licensed pharmacy to be a repository.</text> </level> <level label="b"> <text>Consistent with its approval by the Board, a repository located in the State shall:</text> <level label="1"> <text>Accept only donated prescription drugs, over–the–counter drugs, and medical supplies forwarded by designated drop–off sites;</text> </level> <level label="2"> <text>Inspect all donated prescription drugs, over–the–counter drugs, and medical supplies;</text> </level> <level label="3"> <text>Accept for dispensing to eligible patients only those donated prescription drugs, over–the–counter drugs, and medical supplies that meet the requirements of § 15–603 of this subtitle;</text> </level> <level label="4"> <text>Dispose of donated prescription drugs, over–the–counter drugs, and medical supplies not accepted for dispensing to eligible patients in accordance with State and federal law;</text> </level> <level label="5"> <text>Maintain a separate inventory of donated prescription drugs, over–the–counter drugs, and medical supplies;</text> </level> <level label="6"> <text>Store donated prescription drugs, over–the–counter drugs, and medical supplies in a secure location used exclusively for the Program;</text> </level> <level label="7"> <text>Maintain separate prescription files for patients receiving donated prescription drugs and medical supplies; and</text> </level> <level label="8"> <text>Obliterate from the labels of donated prescription drugs and medical supplies any information specific to the patient for whom the donated prescription drugs, over–the–counter drugs, and medical supplies were originally dispensed or otherwise provided to the patient.</text> </level> </level> <level label="c"> <text>A repository located in the State shall dispense donated prescription drugs, over–the–counter drugs, and medical supplies only:</text> <level label="1"> <text>To an individual who meets the requirements of § 15–606(a) of this subtitle;</text> </level> <level label="2"> <text>On a new prescription, in the case of a prescription drug or medical supply that requires a prescription; and</text> </level> <level label="3"> <text>In accordance with State and federal laws pertaining to:</text> <level label="i"> <text>Storage, distribution, and dispensing of prescription drugs; and</text> </level> <level label="ii"> <text>Confidentiality of patient information.</text> </level> </level> </level> <level label="d"> <text>A repository located in the State may:</text> <level label="1"> <text>Charge a fee, not to exceed $10, for each prescription drug, over–the–counter drug, or medical supply dispensed; and</text> </level> <level label="2"> <text>Dispense a donated prescription drug, over–the–counter drug, or medical supply by mail.</text> </level> </level> <level label="e"> <text>A repository may not establish or maintain a waiting list for any prescription drug, over–the–counter drug, or medical supply dispensed by the Program.</text> </level> <level label="f"> <text>A pharmacy may accept prescription drugs, over–the–counter drugs, and medical supplies taken to the pharmacy for disposal only if the pharmacy is approved by the Board as a repository for this purpose.</text> </level> <level label="g"> <text>Consistent with its approval by the Board, an entity located in another state:</text> <level label="1"> <text>May participate in the Program as a repository; and</text> </level> <level label="2"> <text>Shall dispense donated prescription drugs, over–the–counter drugs, and medical supplies to residents of the State only in accordance with:</text> <level label="i"> <text>Federal law;</text> </level> <level label="ii"> <text>Laws of the state in which the entity is located pertaining to storage and distribution of prescription drugs, over–the–counter drugs, and medical supplies; and</text> </level> <level label="iii"> <text>State laws pertaining to nonresident pharmacies.</text> </level> </level> </level> <level label="h"> <text>The Program may not require a private entity to establish, operate, or fund a drop–off site or disposal program.</text> </level> <level label="i"> <text>The Department shall develop a process for providing information about the availability of the State’s earned income tax credit established under § 10–704 of the Tax – General Article to each individual receiving donated prescription drugs and medical supplies from a repository.</text> </level> <level label="j"> <text>A person donating, transferring, or receiving prescription drugs, over–the–counter drugs, and medical supplies, or facilitating the donation, transfer, or receipt, in accordance with this subtitle may not be required to hold a wholesale distribution license.</text> </level> <level label="k"> <text>A repository located in another state operating primarily for the purpose of participating in a drug donation or repository program may not be required to possess a comprehensive or minimum supply of prescription drugs, over–the–counter drugs, or medical supplies.</text> </level> <level label="l"> <text>A repository located in the State may transfer donated prescription drugs, over–the–counter drugs, and medical supplies to:</text> <level label="1"> <text>Another repository located in the State; or</text> </level> <level label="2"> <text>A drop–off site located in another state, a repository located in another state, or another entity located in another state that participates in a drug donation or repository program in accordance with the laws of the state in which the entity is located only if there is no need for the donated prescription drugs, over–the–counter drugs, or medical supplies for use by eligible patients in the State, as determined by the transferring repository.</text> </level> </level> <level label="m"> <text>Unless otherwise prohibited by federal law or the laws of the state in which it is located, a drop–off site or repository located in another state may perform and receive:</text> <level label="1"> <text>Intracompany transfers of donated prescription drugs, over–the–counter drugs, and medical supplies; and</text> </level> <level label="2"> <text>Transfers of donated prescription drugs, over–the–counter drugs, and medical supplies from drop–off sites located in another state, repositories located in another state, or other entities participating in a drug donation or repository program in accordance with the laws of the state in which the entity is located.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-606" title_number="15" title_name="Assistance Programs" subtitle_number="6" subtitle_name="Prescription Drug Repository Program"> <level label="a"> <text>To be eligible to receive donated prescription drugs, over–the–counter drugs, or medical supplies from a repository located in the State, an individual must:</text> <level label="1"> <text>Be a resident of the State; and</text> </level> <level label="2"> <text>Be an eligible patient.</text> </level> </level> <level label="b"> <text>To be eligible to receive donated prescription drugs, over–the–counter drugs, or medical supplies from a repository located in another state, an individual must be an eligible patient.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-607" title_number="15" title_name="Assistance Programs" subtitle_number="6" subtitle_name="Prescription Drug Repository Program"> <level label="a"> <text>This section applies to:</text> <level label="1"> <text>A person that donates prescription drugs, over–the–counter drugs, or medical supplies to the Program;</text> </level> <level label="2"> <text>A drop–off site;</text> </level> <level label="3"> <text>A repository;</text> </level> <level label="4"> <text>The Board;</text> </level> <level label="5"> <text>Pharmacists;</text> </level> <level label="6"> <text>Pharmacy technicians; and</text> </level> <level label="7"> <text>Staff employed by or volunteering for an entity participating in the Program.</text> </level> </level> <level label="b"> <text>For matters related to donating, accepting, transferring, disposing of, or dispensing prescription drugs, over–the–counter drugs, or medical supplies under the Program, or facilitating the donation, acceptance, transfer, disposition of, or dispensing, a person described in subsection (a) of this section that acts in good faith may not be subject to:</text> <level label="1"> <text>Criminal prosecution; or</text> </level> <level label="2"> <text>Liability in tort or other civil action for injury, death, or loss to person or property.</text> </level> </level> <level label="c"> <text>A drug manufacturer acting in good faith may not be subject to criminal prosecution or liability in tort or other civil action for injury, death, or loss to person or property for matters related to the donation, acceptance, or dispensing of a drug manufactured by the drug manufacturer that is donated by any person under the Program, including liability for failure to transfer or communicate product or consumer information or the expiration date of the donated drug.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-608" title_number="15" title_name="Assistance Programs" subtitle_number="6" subtitle_name="Prescription Drug Repository Program"> <level label="a"> <text>On or before January 1, 2007, and in consideration of the recommendations of the Task Force on the Establishment of a Prescription Drug Repository Program, the Board shall adopt regulations governing the Program.</text> </level> <level label="b"> <text>The regulations shall include:</text> <level label="1"> <text>Categories of drugs that a repository will not accept, including a statement as to why the drug is ineligible for donation;</text> </level> <level label="2"> <text>A standard form each donor donating to a drop–off site located in the State must sign stating that the donor is the owner of the drugs and intends to voluntarily donate them to the Program;</text> </level> <level label="3"> <text>Requirements for designation of drop–off sites to accept donated prescription drugs, over–the–counter drugs, and medical supplies under the Program;</text> </level> <level label="4"> <text>Requirements for designation of repositories to dispense or dispose of donated prescription drugs, over–the–counter drugs, and medical supplies under the Program;</text> </level> <level label="5"> <text>Standards and procedures for drop–off sites and repositories located in the State related to accepting, safely storing, dispensing, shipping, and disposing of donated prescription drugs, over–the–counter drugs, and medical supplies;</text> </level> <level label="6"> <text>Standards and procedures for repositories located in the State related to inspecting donated prescription drugs, over–the–counter drugs, and medical supplies intended for dispensing to determine that:</text> <level label="i"> <text>The prescription drugs and over–the–counter drugs are in original unopened, sealed, and tamper–evident packaging, which may include packaging placed by the manufacturer and packaging placed by an entity authorized to repackage drugs in the state in which the entity is located;</text> </level> <level label="ii"> <text>The medical supplies are in their original unopened and sealed packaging; and</text> </level> <level label="iii"> <text>The prescription drugs, over–the–counter drugs, and medical supplies are unadulterated, safe, and suitable for dispensing;</text> </level> </level> <level label="7"> <text>A standard form that an individual receiving a prescription drug, over–the–counter drug, or medical supply from a repository located in the State must sign before receiving the drug or supply to confirm that the individual understands that:</text> <level label="i"> <text>The individual is receiving prescription drugs, over–the–counter drugs, or medical supplies that have been donated to the Program; and</text> </level> <level label="ii"> <text>Entities involved in the Program have certain immunity from liability;</text> </level> </level> <level label="8"> <text>Record keeping and reporting requirements for a repository located in the State; and</text> </level> <level label="9"> <text>Any other standards and procedures the Board considers appropriate for drop–off sites and repositories located in the State.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-609" title_number="15" title_name="Assistance Programs" subtitle_number="6" subtitle_name="Prescription Drug Repository Program"> <level label="a"> <text>A repository located in the State shall:</text> <level label="1"> <text>Maintain written or electronic records of donated prescription drugs, over–the–counter drugs, and medical supplies; and</text> </level> <level label="2"> <text>Submit periodic reports to the Board on its activities.</text> </level> </level> <level label="b"> <text>To determine compliance with the requirements of this subtitle, the Board shall:</text> <level label="1"> <text>Inspect designated drop–off sites and repositories located in the State;</text> </level> <level label="2"> <text>Inspect records of donated prescription drugs, over–the–counter drugs, and medical supplies maintained by repositories located in the State; and</text> </level> <level label="3"> <text>Beginning January 1, 2007, and each January 1 thereafter, report to the Governor and, in accordance with § 2–1257 of the State Government Article, the General Assembly on the operation of the Program.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-701" title_number="15" title_name="Assistance Programs" subtitle_number="7" subtitle_name="Health Care Coverage Fund"> <level label="a"> <text>In this subtitle, “Fund” means the Health Care Coverage Fund.</text> </level> <level label="b"> <text>There is a Health Care Coverage Fund.</text> </level> <level label="c"> <text>The purpose of the Fund is to:</text> <level label="1"> <text>Support health care coverage for individuals and families with low or moderate income; and</text> </level> <level label="2"> <text>Subject to subsection (i) of this section, support the provision of health care services in Prince George’s County.</text> </level> </level> <level label="d"> <text>The Department and the Maryland Health Care Commission shall administer the Fund.</text> </level> <level label="e"> <level label="1"> <text>The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="2"> <text>The Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.</text> </level> </level> <level label="f"> <text>The Fund consists of:</text> <level label="1"> <text>Money collected from any assessment by the State Health Services Cost Review Commission on hospitals under § 19–214(d) of this article;</text> </level> <level label="2"> <text>Any money made available from investment earnings; and</text> </level> <level label="3"> <text>Any other money from any other source accepted for the benefit of the Fund.</text> </level> </level> <level label="g"> <level label="1"> <text>The Fund shall be invested and reinvested in the same manner as other State funds.</text> </level> <level label="2"> <text>Any investment earnings shall be credited to the Fund.</text> </level> </level> <level label="h"> <text>The Fund may be used only for expenses associated with:</text> <level label="1"> <text>Expanding Medicaid eligibility for parents and caretaker relatives:</text> <level label="i"> <text>Who have a dependent child living with them; and</text> </level> <level label="ii"> <text>Whose annual household income is at or below 116% of the federal poverty guidelines;</text> </level> </level> <level label="2"> <text>Expanding Medicaid eligibility and benefits for individuals:</text> <level label="i"> <text>Who do not meet requirements, such as age, disability, or parent or caretaker relative of a dependent child, for a federal category of eligibility for Medicaid;</text> </level> <level label="ii"> <text>Whose annual household income is at or below 116% of the federal poverty guidelines; and</text> </level> <level label="iii"> <text>Who are not enrolled in the federal Medicare program, as enacted by Title XVIII of the Social Security Act; and</text> </level> </level> <level label="3"> <text>Supporting the provision of health care services in Prince George’s County in accordance with subsection (i) of this section.</text> </level> </level> <level label="i"> <level label="1"> <text>Subject to paragraph (2) of this subsection, in fiscal year 2010, $12,000,000, and in fiscal years 2011 through 2013, up to $10,000,000 may be transferred annually from the Fund to the Department for the purpose of providing a special fund operating grant to an independent entity with authority over the facilities currently operated and health care services currently provided by Dimensions Healthcare System until the facilities and obligation to provide the services are transferred to a new owner or operator.</text> </level> <level label="2"> <text>The Department may not provide a special fund operating grant until a long–term, comprehensive solution to the control and operation of the facilities and provision of health care services currently operated and provided by Dimensions Healthcare System is reached through:</text> <level label="i"> <text>An Act of the General Assembly; or</text> </level> <level label="ii"> <text>A memorandum of understanding between the State and Prince George’s County.</text> </level> </level> <level label="3"> <text>The long–term, comprehensive solution under paragraph (2) of this subsection shall address issues related to health care needs in Prince George’s County and the surrounding region, including:</text> <level label="i"> <text>The transfer to a new owner or operator of the facilities currently operated and the obligation to provide the health care services currently provided by Dimensions Healthcare System;</text> </level> <level label="ii"> <text>A plan for the assets currently held by Prince George’s County related to the facilities currently operated by Dimensions Healthcare System;</text> </level> <level label="iii"> <text>A mechanism to provide a steady revenue stream to help support ongoing operations of the facilities currently operated by Dimensions Healthcare System and to retire the long–term bond indebtedness and satisfy the unfunded pension liability of Dimensions Healthcare System; and</text> </level> <level label="iv"> <text>A mechanism to assure equitable and sustainable funding from Prince George’s County and the State.</text> </level> </level> <level label="4"> <text>Money collected from an assessment by the State Health Services Cost Review Commission on hospitals may not be used for the purpose of this subsection.</text> </level> </level> <level label="j"> <text>Expenditures from the Fund may be made only in accordance with the State budget.</text> </level> <level label="k"> <text>Money from the Fund shall supplement and may not supplant funding for the Maryland Medical Assistance Program.</text> </level> <level label="l"> <text>The Fund is subject to audit by the Office of Legislative Audits.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-702" title_number="15" title_name="Assistance Programs" subtitle_number="7" subtitle_name="Health Care Coverage Fund"> <level label="a"> <text>The Department shall ensure that publicly owned specialty hospitals pay an assessment that is comparable to any uniform assessments imposed by the Health Services Cost Review Commission on specialty hospitals under § 19–214(d) of this article or under Section 16 of Chapter 397 (H.B. 72) of the Acts of the General Assembly of 2011.</text> </level> <level label="b"> <text>Revenues generated from any assessments authorized under subsection (a) of this section shall be used for the general operations of the Medicaid program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-901" title_number="15" title_name="Assistance Programs" subtitle_number="9" subtitle_name="Collective Bargaining by Independent Home Care Providers"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Independent home care provider” means an individual who:</text> <level label="1"> <text>Provides home care services that are directly reimbursed by the State or a fiscal intermediary functioning on behalf of the State, and not by an agency or business that employs employees or refers independent contractors as home care providers, under:</text> <level label="i"> <text>The Medicaid Waiver for Older Adults that is jointly administered by the Department and the Department of Aging as established under § 15–132 of this title, or any successor program;</text> </level> <level label="ii"> <text>The Medicaid Personal Care Program under the State Medical Assistance Program, or any successor program; and</text> </level> <level label="iii"> <text>The In–Home Aide Service Program administered by the Department of Human Services, or any successor program;</text> </level> </level> <level label="2"> <text>Is not employed or referred by an agency or business that employs employees or refers independent contractors as home care providers;</text> </level> <level label="3"> <text>Contracts directly with a program participant for home care services; and</text> </level> <level label="4"> <text>Provides home care services to a program participant personally and does not subcontract with any other party to provide the services to a program participant.</text> </level> </level> <level label="c"> <level label="1"> <text>“Provider organization” means an organization that:</text> <level label="i"> <text>Includes independent home care providers; and</text> </level> <level label="ii"> <text>Has as one of its purposes the representation of independent home care providers in their relations with the State.</text> </level> </level> <level label="2"> <text>“Provider organization” does not include an agency or business that employs employees or refers independent contractors as home care providers.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-902" title_number="15" title_name="Assistance Programs" subtitle_number="9" subtitle_name="Collective Bargaining by Independent Home Care Providers"> <text>In according independent home care providers and their representatives rights under this subtitle, it is the intent of the General Assembly that the State action exemption to the application of federal and State antitrust laws be fully available to the extent that the activities of the independent home care providers and their representatives are authorized under this title.</text> </section> <section article="ghg" article_name="Health - General" number="15-903" title_number="15" title_name="Assistance Programs" subtitle_number="9" subtitle_name="Collective Bargaining by Independent Home Care Providers"> <level label="a"> <text>There shall be only one appropriate bargaining unit of independent home care providers in the State.</text> </level> <level label="b"> <text>Independent home care providers may designate, in accordance with the provisions of this subtitle, which provider organization, if any, shall be the exclusive representative of all independent home care providers in the State.</text> </level> <level label="c"> <level label="1"> <text>The election and certification of the exclusive representative of independent home care providers shall be governed by the procedures set forth in Title 3, Subtitle 4 of the State Personnel and Pensions Article.</text> </level> <level label="2"> <text>All elections shall be conducted by the Public Employee Relations Board and subject to the requirements and limitations of Title 22, Subtitle 4 of the State Government Article.</text> </level> <level label="3"> <text>The Public Employee Relations Board may not conduct an election for an exclusive representative if an election or certification of an exclusive representative has taken place within the preceding 2 years.</text> </level> <level label="4"> <text>A provider organization designated as the exclusive representative shall represent all independent home care providers in the State fairly and without discrimination, whether or not the independent home care providers are members of the provider organization.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-904" title_number="15" title_name="Assistance Programs" subtitle_number="9" subtitle_name="Collective Bargaining by Independent Home Care Providers"> <level label="a"> <text>The Department and the departments of Human Services and Aging shall designate appropriate representatives to participate in collective bargaining with the provider organization certified as the exclusive representative of independent home care providers.</text> </level> <level label="b"> <text>Except as otherwise provided in this subtitle, the parties shall adhere to the bargaining process set forth in § 3–501 of the State Personnel and Pensions Article.</text> </level> <level label="c"> <text>The State agencies specified in subsection (a) of this section that are engaged in bargaining shall negotiate, in consultation with the Department of Budget and Management, all matters that require appropriation of State funds.</text> </level> <level label="d"> <text>Collective bargaining shall include all matters relating to the terms and conditions of participation by independent home care providers in the provision of home care services under the programs specified in § 15–901(b) of this subtitle, including:</text> <level label="1"> <text>Reimbursement rates;</text> </level> <level label="2"> <text>Benefits;</text> </level> <level label="3"> <text>Payment procedures;</text> </level> <level label="4"> <text>Contract grievance procedures;</text> </level> <level label="5"> <text>Training;</text> </level> <level label="6"> <text>Member dues deductions; and</text> </level> <level label="7"> <text>Other terms and conditions of participation by independent home care providers in the provision of home care services under the programs specified in § 15–901(b) of this subtitle.</text> </level> </level> <level label="e"> <level label="1"> <level label="i"> <text>Subject to subparagraphs (ii) and (iii) of this paragraph, collective bargaining may include negotiations relating to the right of a provider organization that is the exclusive representative to receive service fees from nonmembers.</text> </level> <level label="ii"> <text>The representatives of the State may not reach an agreement containing a service fee provision unless the representatives of the State conclude that the agreement as a whole will not adversely impact nonmember providers.</text> </level> <level label="iii"> <text>The representatives of the State may only agree to a service fee provision if the service fee provision would require nonmembers to pay service fees on a sliding scale in approximate proportion to the amount each nonmember receives in reimbursement through:</text> <level label="1"> <text>The Medicaid Waiver for Older Adults that is jointly administered by the Department and the Department of Aging as established under § 15–132 of this title, or any successor program;</text> </level> <level label="2"> <text>The Medicaid Personal Care Program under the State Medical Assistance Program, or any successor program; and</text> </level> <level label="3"> <text>The In–Home Aide Service Program administered by the Department of Human Services, or any successor program.</text> </level> </level> </level> <level label="2"> <text>An independent home care provider whose religious beliefs are opposed to joining or financially supporting any collective bargaining organization:</text> <level label="i"> <text>Is not required to pay a service fee; but</text> </level> <level label="ii"> <text>Shall pay an amount of money as determined in collective bargaining negotiations, not to exceed any service fee negotiated under paragraph (1) of this subsection, to any charitable organization exempt from taxation under § 501(c)(3) of the Internal Revenue Code and to furnish to the State agencies engaged in collective bargaining under this subtitle and the exclusive representative written proof of the payment.</text> </level> </level> <level label="3"> <level label="i"> <text>An independent home care provider who provides home care services only to an immediate family member is not required to pay a service fee.</text> </level> <level label="ii"> <text>An independent home care provider who provides services to an immediate family member and any other individual who is not an immediate family member may be required to pay a service fee that is proportionate to the amount the provider receives in reimbursement for the provider’s services to any individual who is not an immediate family member.</text> </level> <level label="iii"> <text>An independent home care provider may be required to provide written documentation of the provision of home care services to an immediate family member.</text> </level> </level> </level> <level label="f"> <text>Notwithstanding subsection (d) of this section, the representatives of the State:</text> <level label="1"> <text>May not be required to negotiate any matter that is inconsistent with applicable law; and</text> </level> <level label="2"> <text>May negotiate and reach agreement with regard to any matter that is inconsistent with applicable law only if it is understood that the agreement with respect to the matter cannot become effective unless the applicable law is amended by the General Assembly in a manner that eliminates inconsistency.</text> </level> </level> <level label="g"> <level label="1"> <text>The parties shall reduce their agreement to a Memorandum of Understanding that complies with the provisions of § 3–601 of the State Personnel and Pensions Article.</text> </level> <level label="2"> <text>If the Memorandum of Understanding contains a service fee provision, before the vote to ratify the Memorandum of Understanding is held, the exclusive representative shall provide notice that the Memorandum of Understanding contains a provision for a service fee that will be charged on a sliding scale to independent home care providers.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-905" title_number="15" title_name="Assistance Programs" subtitle_number="9" subtitle_name="Collective Bargaining by Independent Home Care Providers"> <text>The certification of an exclusive representative of independent home care providers by the State agencies engaged in collective bargaining under this subtitle does not prevent the certified provider organization or any other organization or individual from communicating with any State official on matters of interest, including appearing before or making proposals to the State agencies engaged in collective bargaining at a public meeting or hearing or at any other forum of the State agencies.</text> </section> <section article="ghg" article_name="Health - General" number="15-906" title_number="15" title_name="Assistance Programs" subtitle_number="9" subtitle_name="Collective Bargaining by Independent Home Care Providers"> <level label="a"> <text>A provider organization may not call or direct a strike or other collective cessation of the delivery of services.</text> </level> <level label="b"> <text>This subtitle may not be construed to grant any right, or imply that independent home care providers have any right, to engage in a strike or other collective cessation of the delivery of services.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-907" title_number="15" title_name="Assistance Programs" subtitle_number="9" subtitle_name="Collective Bargaining by Independent Home Care Providers"> <level label="a"> <text>This subtitle may not be construed to make independent home care providers employees of the State.</text> </level> <level label="b"> <text>This subtitle may not be construed in any way to deny program recipients of independent home care services the right to select, direct, and terminate the services of independent home care providers.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-1001" effective_note="EFFECTIVE UNTIL DECEMBER 31, 2030 PER CHAPTER 48 OF 2024" title_number="15" title_name="Assistance Programs" subtitle_number="10" subtitle_name="Senior Prescription Drug Assistance Program"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Eligible individual” means an individual who:</text> <level label="1"> <text>Is a resident of Maryland;</text> </level> <level label="2"> <text>Is a Medicare beneficiary enrolled in the Medicare Part D Voluntary Prescription Drug Benefit Program or a Medicare Advantage Plan that provides Part D coverage;</text> </level> <level label="3"> <text>Is not enrolled in a health benefit plan, other than a Medicare Part D prescription drug plan or a Medicare Advantage Plan, that provides prescription drug benefits at the time that the individual applies for enrollment in the Program;</text> </level> <level label="4"> <text>Has an annual household income at or below 300% of the federal poverty guidelines;</text> </level> <level label="5"> <text>Is not eligible for a full federal low–income subsidy under 42 C.F.R. § 423.772; and</text> </level> <level label="6"> <text>Pays the premium, and copayments or coinsurance, for the Program.</text> </level> </level> <level label="c"> <text>“Enrollee” means an individual enrolled in the Program.</text> </level> <level label="d"> <text>“Fund” means the Senior Prescription Drug Assistance Program Fund established under § 15–1004 of this subtitle.</text> </level> <level label="e"> <text>“Program” means the Senior Prescription Drug Assistance Program established under this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-1002" effective_note="EFFECTIVE DECEMBER 31, 2030 PER CHAPTER 48 OF 2024" title_number="15" title_name="Assistance Programs" subtitle_number="10" subtitle_name="Senior Prescription Drug Assistance Program"> <level label="a"> <text>There is a Senior Prescription Drug Assistance Program.</text> </level> <level label="b"> <text>The purpose of the Program is to provide Medicare Part D beneficiaries, who meet Program eligibility requirements, with a State subsidy.</text> </level> <level label="c"> <text>The Department shall administer the Program.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-1003" effective_note="EFFECTIVE DECEMBER 31, 2030 PER CHAPTER 48 OF 2024" title_number="15" title_name="Assistance Programs" subtitle_number="10" subtitle_name="Senior Prescription Drug Assistance Program"> <level label="a"> <text>The Program shall:</text> <level label="1"> <text>Provide a prescription drug benefit subsidy, as determined by the Department, that may pay all or some of the deductibles, coinsurance payments, premiums, and copayments under the federal Medicare Part D Pharmaceutical Assistance Program for enrollees of the Program; and</text> </level> <level label="2"> <text>Provide the subsidy to the maximum number of individuals eligible for enrollment in the Program, subject to the money available in the Fund.</text> </level> </level> <level label="b"> <text>The Program may limit payment of any subsidy by paying the subsidy only on behalf of eligible individuals enrolled in a Medicare Part D Prescription Drug Plan or Medicare Advantage Plan that coordinates with the Program in accordance with federal requirements.</text> </level> <level label="c"> <text>The Program may annually provide an additional subsidy, up to the full amount of the Medicare Part D Prescription Drug Plan premium, for individuals who qualify for a partial federal low–income subsidy.</text> </level> <level label="d"> <text>The Department shall maintain a waiting list of individuals who meet the eligibility requirements for the Program but who are not served by the Program due to funding limitations.</text> </level> <level label="e"> <text>The Department shall determine annually:</text> <level label="1"> <text>The number of individuals to be enrolled in the Program;</text> </level> <level label="2"> <text>The amount of subsidy to be provided under subsection (a) of this section; and</text> </level> <level label="3"> <text>The amount of any additional subsidy provided under subsection (c) of this section.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-1004" effective_note="EFFECTIVE UNTIL DECEMBER 31, 2030 PER CHAPTER 48 OF 2024" title_number="15" title_name="Assistance Programs" subtitle_number="10" subtitle_name="Senior Prescription Drug Assistance Program"> <level label="a"> <text>There is a Senior Prescription Drug Assistance Program Fund.</text> </level> <level label="b"> <text>The purpose of the Fund is to support the administration, operation, and activities of the Program.</text> </level> <level label="c"> <text>The Department shall administer the Fund.</text> </level> <level label="d"> <level label="1"> <text>The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="2"> <text>The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.</text> </level> </level> <level label="e"> <text>The Fund consists of:</text> <level label="1"> <text>Money transferred to the Fund by a nonprofit health service plan under § 14–106(d) of the Insurance Article;</text> </level> <level label="2"> <text>Money appropriated in the State budget to the Fund;</text> </level> <level label="3"> <text>Interest earnings of the Fund; and</text> </level> <level label="4"> <text>Any other money from any other source accepted for the benefit of the Fund.</text> </level> </level> <level label="f"> <level label="1"> <text>Except as provided in paragraphs (2) and (3) of this subsection, the Fund may be used only for the administration, operation, and activities of the Program.</text> </level> <level label="2"> <text>For fiscal year 2025 and each fiscal year thereafter, excess funds not required for the administration, operation, and activities of the Program may be used only to subsidize:</text> <level label="i"> <text>The Kidney Disease Program under Title 13, Subtitle 3 of this article; or</text> </level> <level label="ii"> <text>The provision of mental health services to the uninsured under Title 10, Subtitle 2 of this article.</text> </level> </level> <level label="3"> <text>For fiscal year 2025 and each fiscal year thereafter, excess funds not required for the administration, operation, and activities of the Program may be used for health reimbursement accounts established in accordance with § 105(h) of the Internal Revenue Code under § 2–509.1 of the State Personnel and Pensions Article.</text> </level> </level> <level label="g"> <level label="1"> <text>The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested.</text> </level> <level label="2"> <text>Any interest earnings of the Fund shall be credited to the Fund.</text> </level> </level> <level label="h"> <level label="1"> <text>Expenditures from the Fund may be made only in accordance with the State budget.</text> </level> <level label="2"> <text>The Program shall have its own program code within the State budget.</text> </level> </level> <level label="i"> <level label="1"> <text>Beginning July 1, 2016, and quarterly thereafter, the nonprofit health service plan required to subsidize the Program under § 14–106(d) of the Insurance Article shall deposit to the Fund the amount that is necessary to operate and administer the Program for the following quarter.</text> </level> <level label="2"> <text>The amount deposited shall be determined by the Department based on enrollment, expenditures, and revenue for the previous year.</text> </level> <level label="3"> <text>The amount required by the Department under paragraph (2) of this subsection may not exceed the amounts specified in § 14–106(e) of the Insurance Article.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-1005" effective_note="EFFECTIVE UNTIL DECEMBER 31, 2030 PER CHAPTER 48 OF 2024" title_number="15" title_name="Assistance Programs" subtitle_number="10" subtitle_name="Senior Prescription Drug Assistance Program"> <level label="a"> <text>On or before June 30 of each year, the Department shall submit a report to the Governor and, in accordance with § 2–1257 of the State Government Article, to the General Assembly that includes a summary of Program activities for the year and any recommendations for consideration by the General Assembly.</text> </level> <level label="b"> <level label="1"> <text>The Department shall adopt regulations to carry out this subtitle.</text> </level> <level label="2"> <text>The Department may adopt regulations that require an insurance producer to receive training about the Program before the insurance producer may market the Program or assist a Medicare beneficiary to enroll in the Program.</text> </level> <level label="3"> <text>Subject to § 10–116(d) of the Insurance Article, training received under paragraph (2) of this subsection qualifies as continuing education under § 10–116(a) of the Insurance Article.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-1006" effective_note="EFFECTIVE UNTIL DECEMBER 31, 2030 PER CHAPTER 48 OF 2030" title_number="15" title_name="Assistance Programs" subtitle_number="10" subtitle_name="Senior Prescription Drug Assistance Program"> <level label="a"> <text>For the purpose of maximizing participation in the Program, the Department may develop outreach materials for distribution to eligible individuals.</text> </level> <level label="b"> <text>The Department shall publicize the existence and eligibility requirements of the Program through the following entities:</text> <level label="1"> <text>The Department of Aging;</text> </level> <level label="2"> <text>Local health departments;</text> </level> <level label="3"> <text>Continuing care retirement communities;</text> </level> <level label="4"> <text>Places of worship;</text> </level> <level label="5"> <text>Civic organizations;</text> </level> <level label="6"> <text>Community pharmacies; and</text> </level> <level label="7"> <text>Any other entity that the Department determines appropriate.</text> </level> </level> <level label="c"> <text>The Department of Aging, through its Senior Health Insurance Program, shall:</text> <level label="1"> <text>Assist eligible individuals in applying for coverage under the Program; and</text> </level> <level label="2"> <text>Provide notice of the Program and its eligibility requirements to potentially eligible individuals who seek health insurance counseling services through the Department of Aging.</text> </level> </level> <level label="d"> <text>The Department shall develop a mail–in application for the Program.</text> </level> <level label="e"> <text>Any outreach performed by the Department on behalf of the Program shall be funded through the Fund.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-1007" title_number="15" title_name="Assistance Programs" subtitle_number="10" subtitle_name="Senior Prescription Drug Assistance Program"> <text>The Department shall develop a process for providing information about the availability of the State’s earned income tax credit established under § 10–704 of the Tax – General Article to each individual receiving services under this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="15-1101" title_number="15" title_name="Assistance Programs" subtitle_number="11" subtitle_name="Home-Based and Community-Based Services for Children and Youth"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Family–centered treatment” means an evidence–based practice used to stabilize youth in the home by addressing underlying functions of behavior in order to reduce disruptions in the home, school, and community.</text> </level> <level label="c"> <text>“Functional family therapy” means a family–based prevention and intervention program for high–risk youth that addresses complex and multidimensional problems through clinical practice that is flexibly structured and culturally sensitive.</text> </level> <level label="d"> <text>“High–fidelity wraparound model” means a research–based model of care coordination that uses a highly structured, team–based, family–centered management process to meet the needs of children and adolescents who experience complex emotional, behavioral, or mental health needs.</text> </level> <level label="e"> <text>“Mental health case management program” means a program that provides an identified subset of wraparound services.</text> </level> <level label="f"> <text>“1915(i) model” means the 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families program established under Title 10, Subtitle 9, Chapter 89 of the Code of Maryland Regulations.</text> </level> <level label="g"> <text>“Value–based purchasing” means financially incentivizing providers to meet selected outcome measures.</text> </level> <level label="h"> <text>“Wraparound services” means services provided to children and youth with intensive mental health needs and their families in their communities, including:</text> <level label="1"> <text>Intensive care coordination;</text> </level> <level label="2"> <text>Child and family team meetings; and</text> </level> <level label="3"> <text>Plans of care that are individualized to each family and include:</text> <level label="i"> <text>Formal supports, including individual and family therapy; and</text> </level> <level label="ii"> <text>Informal supports, including intensive in–home services, respite care, mobile crisis response and stabilization, family peer support, experiential therapies, and flexible funds for goods and services that are identified in the plan of care.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-1102" title_number="15" title_name="Assistance Programs" subtitle_number="11" subtitle_name="Home-Based and Community-Based Services for Children and Youth"> <level label="a"> <text>The Department shall ensure that care coordinators delivering services under the 1915(i) model or a mental health case management program receive training in the delivery of services under a high–fidelity wraparound model.</text> </level> <level label="b"> <text>The Department shall provide reimbursement for:</text> <level label="1"> <text>Wraparound services delivered by care coordinators under a high–fidelity wraparound model under the 1915(i) model or a mental health case management program that is commensurate with industry standards for the reimbursement of the delivery of wraparound services;</text> </level> <level label="2"> <text>Intensive in–home services delivered by providers using family–centered treatment, functional family therapy, and other evidence–based practices under the 1915(i) model that is commensurate with the industry standards for the reimbursement of the delivery of family–centered treatment, functional family therapy, and other evidence–based practices; and</text> </level> <level label="3"> <text>At least one pilot program utilizing value–based purchasing for case management services.</text> </level> </level> <level label="c"> <text>Beginning in fiscal year 2024, the Behavioral Health Administration shall fund 100 slots in the mental health case management program for children or youth who are not eligible for program services and who are at risk of out–of–home placement.</text> </level> <level label="d"> <text>The Governor shall include in the annual operating budget bill the following amounts to fund customized goods and services for youth receiving services under the 1915(i) model or mental health case management program:</text> <level label="1"> <text>$150,000 for fiscal year 2025;</text> </level> <level label="2"> <text>$250,000 for fiscal year 2026; and</text> </level> <level label="3"> <text>$350,000 for fiscal year 2027 and each fiscal year thereafter.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-1103" title_number="15" title_name="Assistance Programs" subtitle_number="11" subtitle_name="Home-Based and Community-Based Services for Children and Youth"> <level label="a"> <text>On or before December 1 each year, beginning in 2023, the Department shall report to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, on enrollment in:</text> <level label="1"> <text>The 1915(i) model; and</text> </level> <level label="2"> <text>Child and adolescent case management services.</text> </level> </level> <level label="b"> <text>The report shall include:</text> <level label="1"> <text>The total number of children and adolescents served by each program;</text> </level> <level label="2"> <text>Whether the number represents an increase or a decrease in the number served; and</text> </level> <level label="3"> <text>Any steps the Department has taken to increase enrollment in the programs.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-1201" title_number="15" title_name="Assistance Programs" subtitle_number="12" subtitle_name="Maryland Interested Parties Advisory Group"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Advisory Group” means the Maryland Interested Parties Advisory Group established under § 15–1202 of this subtitle and required under 42 C.F.R. § 447.203.</text> </level> <level label="c"> <text>“Applicable service categories” means homemaker services, home health aide services, personal care services, and habilitation services.</text> </level> <level label="d"> <text>“Consumer” means an applicant for, a recipient of, or an individual eligible for Medicaid home– and community–based services, or the individual’s authorized representative.</text> </level> <level label="e"> <text>“Consumer organization” means a State or local consumer advocacy group or other community–based organization that represents the interests of, or provides direct services to, consumers of Medicaid home– and community–based services.</text> </level> <level label="f"> <text>“Direct care worker” means an individual:</text> <level label="1"> <text>Employed by a Medicaid provider, State agency, or third party;</text> </level> <level label="2"> <text>Who contracts with a Medicaid provider, State agency, or third party;</text> </level> <level label="3"> <text>Delivering services under a self–directed services delivery model; or</text> </level> <level label="4"> <text>Who is paid to provide home– and community–based services through an applicable service category.</text> </level> </level> <level label="g"> <text>“Home– and community–based services” means Medicaid home– and community–based services delivered through the State plan, a waiver under § 1915(c) of the federal Social Security Act, a managed care program, or other demonstration program.</text> </level> <level label="h"> <text>“Personal care” has the meaning stated under § 19–301 of this article.</text> </level> <level label="i"> <text>“Provider association” means a trade association that represents direct care employers.</text> </level> <level label="j"> <text>“Worker organization” means an organization that:</text> <level label="1"> <text>Is exempt from federal income taxation under §§ 501(c)(3) through (6) of the Internal Revenue Code;</text> </level> <level label="2"> <text>Is not dominated, controlled, or funded by a direct care employer; and</text> </level> <level label="3"> <text>Has at least 2 years of demonstrated experience engaging with and advocating for direct care workers.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-1202" title_number="15" title_name="Assistance Programs" subtitle_number="12" subtitle_name="Maryland Interested Parties Advisory Group"> <level label="a"> <text>There is a Maryland Interested Parties Advisory Group within the Department.</text> </level> <level label="b"> <text>The primary purpose of the Advisory Group is to advise and consult on Medicaid payment rate sufficiency, ensuring adequate access to applicable service categories.</text> </level> </section> <section article="ghg" article_name="Health - General" number="15-1203" title_number="15" title_name="Assistance Programs" subtitle_number="12" subtitle_name="Maryland Interested Parties Advisory Group"> <level label="a"> <text>The Advisory Group consists of:</text> <level label="1"> <text>The Deputy Secretary of Health Care Financing, or the Deputy Secretary’s designee;</text> </level> <level label="2"> <text>The Secretary of Labor, or the Secretary’s designee; and</text> </level> <level label="3"> <text>The following members appointed by the Deputy Secretary of Health Care Financing, or the Deputy Secretary’s designee:</text> <level label="i"> <text>Three consumers;</text> </level> <level label="ii"> <text>Two representatives of consumer organizations;</text> </level> <level label="iii"> <text>Three direct care workers;</text> </level> <level label="iv"> <text>Two representatives of worker organizations; and</text> </level> <level label="v"> <text>Three representatives of provider associations, of whom:</text> <level label="1"> <text>Two shall be representatives of a residential service agency; and</text> </level> <level label="2"> <text>One shall be a representative of an employer trade association.</text> </level> </level> </level> </level> <level label="b"> <text>To the extent practicable, the members appointed to the Advisory Group shall reflect the diversity of lived experience with disability, as well as the geographic, racial, ethnic, cultural, gender, sexual orientation, gender identity, gender expression, age, and socioeconomic diversity of the State.</text> </level> <level label="c"> <level label="1"> <text>The Deputy Secretary of Health Care Financing, or the Deputy Secretary’s designee, shall establish an application process that is accessible to the general public for the recruitment of members.</text> </level> <level label="2"> <text>The application and criteria for selection shall be published on the Department’s website.</text> </level> </level> <level label="d"> <level label="1"> <text>The Deputy Secretary of Health Care Financing, or the Deputy Secretary’s designee, shall chair the Advisory Group.</text> </level> <level label="2"> <text>The Department shall provide staff and support for the Advisory Group, including appropriate logistical and informational support to ensure meaningful participation of direct care workers and consumers in the Advisory Group.</text> </level> </level> <level label="e"> <text>The Secretary may remove or suspend a member of the Advisory Group for misconduct, incompetence, or neglect of duties after an opportunity for the member to be heard.</text> </level> <level label="f"> <text>A member of the Advisory Group:</text> <level label="1"> <text>May not receive compensation as a member of the Advisory Group; but</text> </level> <level label="2"> <text>Is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.</text> </level> </level> <level label="g"> <level label="1"> <text>Beginning November 1, 2025, the Advisory Group shall meet annually.</text> </level> <level label="2"> <text>Meeting dates, times, and locations shall be selected to maximize member attendance.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-1204" title_number="15" title_name="Assistance Programs" subtitle_number="12" subtitle_name="Maryland Interested Parties Advisory Group"> <level label="a"> <level label="1"> <text>The Department shall establish standardized procedures for the administration of the Advisory Group and make the procedures available to the public on a dedicated page of the Department’s website.</text> </level> <level label="2"> <text>The dedicated page on the Department’s website shall also include:</text> <level label="i"> <text>A list of current Advisory Group members;</text> </level> <level label="ii"> <text>The application process and selection criteria for Advisory Group members;</text> </level> <level label="iii"> <text>The location, date, and time of each Advisory Group meeting with at least 30 calendar days’ advance notice;</text> </level> <level label="iv"> <text>Options for virtual participation in meetings of the Advisory Group;</text> </level> <level label="v"> <text>Procedures to ensure meaningful participation for individuals with disabilities and limited English proficiency;</text> </level> <level label="vi"> <text>A notation of at which meetings the general public will have an opportunity to testify or make comments; and</text> </level> <level label="vii"> <text>In accordance with the Open Meetings Act, the agenda and meeting minutes of the previous meeting of the Advisory Group, including a list of meeting attendees.</text> </level> </level> </level> <level label="b"> <text>The Department shall provide sufficient data and resources at least 30 days in advance of a meeting to support informed participation in Advisory Group discussions, including:</text> <level label="1"> <text>Current and proposed payment rates;</text> </level> <level label="2"> <text>Federally required information, including:</text> <level label="i"> <text>Home– and community–based services payment transparency reports;</text> </level> <level label="ii"> <text>Payment adequacy reports as required under 42 C.F.R. § 441.311(e); and</text> </level> <level label="iii"> <text>Access–to–care data, as required under 42 C.F.R. § 441.311(d)(2);</text> </level> </level> <level label="3"> <text>Bureau of Labor Statistics publicly available wage data and other labor market and workforce data;</text> </level> <level label="4"> <text>Benchmarking and rate studies for home– and community–based services conducted by the Department;</text> </level> <level label="5"> <text>Rate information from neighboring or similarly situated states; and</text> </level> <level label="6"> <text>Access–to–care metrics, including:</text> <level label="i"> <text>The number of consumers receiving applicable services; and</text> </level> <level label="ii"> <text>The number of utilization hours for applicable service categories.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="15-1205" title_number="15" title_name="Assistance Programs" subtitle_number="12" subtitle_name="Maryland Interested Parties Advisory Group"> <level label="a"> <text>The Advisory Group shall:</text> <level label="1"> <text>Evaluate the sufficiency of Medicaid payment rates for applicable service categories; and</text> </level> <level label="2"> <text>Evaluate challenges to accessing care for applicable Medicaid home– and community–based services.</text> </level> </level> <level label="b"> <level label="1"> <text>On or before September 1 each year, beginning in 2026, the Advisory Group shall report its activities and recommendations to the Governor and, in accordance with § 2–1257 of the State Government Article, the General Assembly.</text> </level> <level label="2"> <text>Any recommendations adopted by the Advisory Group must receive a majority vote.</text> </level> </level> <level label="c"> <text>The Department shall post the report to the Department’s website within 30 days after the report has been finalized.</text> </level> <level label="d"> <text>The Advisory Group may hold opportunities to solicit and collect testimony from the public and invite input from employer organizations, worker organizations, consumer advocacy groups, and other stakeholders in the direct care industry.</text> </level> <level label="e"> <level label="1"> <text>An employer or State agency may not take retaliatory action against a direct care worker or consumer for participation in the Advisory Group.</text> </level> <level label="2"> <text>This section does not limit the rights of direct care workers under State or federal employment or labor law, or collective bargaining agreements.</text> </level> </level> </section>