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<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>
