In this subtitle the following words have the meanings indicated. “Affordable Care Act” means the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010, and any regulations adopted or guidance issued under the Acts. “Commission” means the Maryland Community Health Resources Commission. “Community health resource” means a nonprofit or for profit health care center or program that offers the primary health care services required by the Commission under § 19–2109(a)(2) of this subtitle to an individual on a sliding scale fee schedule and without regard to an individual’s ability to pay. “Community health resource” includes: A federally qualified health center; A federally qualified health center “look–alike”; A community health center; A migrant health center; A health care program for the homeless; A primary care program for a public housing project; A local nonprofit and community–owned health care program; A school–based health center; A teaching clinic; A wellmobile; A health center controlled operating network; A historic Maryland primary care provider; An outpatient behavioral health program; and Any other center or program identified by the Commission as a community health resource.

There is a Maryland Community Health Resources Commission. The Commission is an independent commission that operates within the Department. The purpose of the Commission is to increase access to health care through community health resources.

The Commission consists of eleven members appointed by the Governor with the advice and consent of the Senate. Of the eleven members: One shall be a representative of a nonprofit health maintenance organization; One shall be a representative of a nonprofit health service plan; One shall be a representative of a Maryland hospital; Four shall be individuals who: Do not have any connection with the management or policy of a community health resource, nonprofit health service plan, or nonprofit health maintenance organization; and Have a background or experience in health care; One shall be an individual who has a background or experience with an outpatient mental health clinic within the past 5 years; and Three shall be individuals who have a background or experience with a community health resource within the past 5 years. At least two of the eleven members shall be health care professionals licensed in the State. To the extent practicable, when appointing members to the Commission, the Governor shall assure geographic balance and promote racial and gender diversity in the Commission’s membership. On or after July 1, 2009, the term of a member is 4 years. The terms of members are staggered as required by the terms provided for members of the Commission on July 1, 2009. At the end of a term, a member continues to serve until a successor is appointed and qualifies. A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies. A member may not serve more than two consecutive terms, except that a member appointed before July 1, 2009, may serve one additional 4–year term when the member’s current term expires. The Governor may remove a member for neglect of duty, incompetence, or misconduct.

From among the members of the Commission: The Governor shall appoint a chair; and The chair shall appoint a vice chair.

With the approval of the Governor, the Commission shall appoint an Executive Director, who is the chief administrative officer of the Commission. The Executive Director serves at the pleasure of the Commission. Under the direction of the Commission, the Executive Director shall perform any duty or function that the Commission requires.

A majority of the full authorized membership of the Commission is a quorum. The decision of the Commission shall be by a majority of the quorum present and voting. The Commission shall meet at least six times a year, at the times and places that it determines. A member of the Commission is entitled to: Compensation in accordance with the State budget; and Reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget. The Commission may employ a staff in accordance with the State budget. The Commission, in consultation with the Secretary, shall determine the appropriate job classifications and grades for all staff. The Commission, in consultation with the Secretary, may set the compensation of a Commission employee in a position that: Is unique to the Commission; Requires specific skills or experience to perform the duties of the position; and Does not require the employee to perform functions that are comparable to functions performed in other units of the Executive Branch of State government. The Secretary of Budget and Management, in consultation with the Commission, shall determine the positions for which the Commission may set compensation under paragraph (3) of this subsection.

In addition to the powers set forth elsewhere in this subtitle, the Commission may: Adopt regulations to carry out the provisions of this subtitle; Create committees from among its members; Appoint advisory committees, which may include individuals and representatives of interested public or private organizations; Apply for and accept any funds, property, or services from any person or government agency; Make agreements with a grantor or payor of funds, property, or services, including an agreement to make any study, plan, demonstration, or project; Publish and give out any information that relates to expanding access to health care through community health resources that is considered desirable in the public interest; Subject to the limitations of this subtitle, exercise any other power that is reasonably necessary to carry out the purposes of this subtitle; and Assist community health resources in preparing to implement the Affordable Care Act. In addition to the duties set forth elsewhere in this subtitle, the Commission shall: Adopt rules and regulations that relate to its meetings, minutes, and transactions; Keep minutes of each meeting; Prepare annually a budget proposal that includes the estimated income of the Commission and proposed expenses for its administration and operation; and On or before October 1 of each year, submit to the Governor, to the Secretary, and, in accordance with § 2–1257 of the State Government Article, to the General Assembly an annual report on the operations and activities of the Commission during the preceding fiscal year. The Commission may contract with a qualified, independent third party for any service that is necessary to carry out the powers and duties of the Commission. Unless permission is granted specifically by the Commission, a third party with whom the Commission contracts under paragraph (1) of this subsection may not release, publish, or use in a manner not authorized by the contract any information to which the third party has access under the contract.

The power of the Secretary over plans, proposals, and projects of units in the Department does not include the power to disapprove or modify any decision or determination that the Commission makes under authority specifically delegated by law to the Commission. The power of the Secretary to transfer by rule, regulation, or written directive any staff, functions, or funds of units in the Department does not apply to any staff, functions, or funds of the Commission. The power of the Secretary over the procurement procedure for units in the Department does not apply to the procurement procedure of the Commission. Notwithstanding paragraph (1) of this subsection, when procuring services or supplies, the Commission is subject to the provisions of the State Finance and Procurement Article.

In addition to the duties set forth elsewhere in this subtitle, the Commission shall, to the extent budgeted resources permit: Establish by regulation the criteria to qualify as a community health resource under this subtitle; Establish by regulation the services that a community health resource shall provide to qualify as a community health resource under this subtitle; Require community health resources to submit a plan to the Commission on how the community health resource will provide or arrange to provide mental health services; Identify and seek federal and State funding for the expansion of community health resources; Establish by regulation the criteria for community health resources to qualify for operating grants and procedures for applying for operating grants; Administer operating grant fund programs for qualifying community health resources; Taking into consideration regional disparities in income and the cost of medical services, establish guidelines for sliding scale fee payments at community health resources that are not federally qualified health centers, for individuals whose family income is between 100% and 200% of the federal poverty guidelines; Identify and implement programs and policies to encourage specialist providers to serve individuals referred from community health resources; Identify and implement programs and policies to encourage hospitals and community health resources to partner to increase access to health care services; Establish a reverse referral pilot program under which a hospital will identify and assist patients in accessing health care services through a community health resource; Work with community health resources, hospital systems, and others to develop a unified information and data management system for use by all community health resources that is integrated with the local hospital systems to track the treatment of individual patients and that provides real–time indicators of available resources; Work in cooperation with clinical education and training programs, area health education centers, and telemedicine centers to enhance access to quality primary and specialty health care for individuals in rural and underserved areas referred by community health resources; Evaluate the feasibility of developing a capital grant program for community health resources that are not federally qualified health centers; Develop an outreach program to educate and inform individuals of the availability of community health resources and assist individuals under 200% of the federal poverty level who do not have health insurance to access health care services through community health resources; Study school–based health center funding and access issues including: Reimbursement of school–based health centers by managed care organizations, insurers, nonprofit health service plans, and health maintenance organizations; and Methods to expand school–based health centers to provide primary care services; Study access and reimbursement issues regarding the provision of dental services; Evaluate the feasibility of extending liability protection under the Maryland Tort Claims Act to health care practitioners who contract directly with a community health resource that is also a Maryland qualified health center or a school–based health center; and Establish criteria and mechanisms to pay for office–based specialty care visits, diagnostic testing, and laboratory tests for uninsured individuals with family income that does not exceed 200% of the federal poverty guidelines who are referred through community health resources. The reverse referral pilot program established under subsection (a)(10) of this section shall include at least one hospital and one community health resource from a rural, urban, and suburban area of this State. The Commission, in developing and implementing the outreach program established under subsection (a)(14) of this section, shall consult and coordinate with the Motor Vehicle Administration, workforce development boards, local departments of social services, local health departments, Medbank Inc., the Comptroller, the Maryland Health Care Commission, hospitals, community health resources, and physicians to provide outreach and consumer information. The Commission, in conducting the school–based health center study required under subsection (a)(15) of this section, shall: Solicit input from and consult with local governments that operate school–based health centers, the State Department of Education, the Maryland Insurance Commissioner, representatives from school–based health centers, providers, and insurers; and Identify the following: A fee schedule for individuals accessing a school–based community health center; Reimbursement rates to be paid by managed care organizations and insurers, nonprofit health services plans, and health maintenance organizations to the school–based community health center; Insurance payments owed to school–based community health centers and how much of the payments should be collected to offset any State subsidy; Barriers to the reimbursement of licensed health care providers who provide services at school–based health centers, including nurse practitioners and physician assistants; A system of registering individuals who receive health care services from a school–based community health center that requires an individual to pay premiums and sliding scale fees; and Security measures to be used by school–based community health centers. The Commission, in conducting the dental services study required under subsection (a)(16) of this section, shall select input from and consult with community health resources that provide dental services, managed care organizations, the University of Maryland School of Dentistry, and dental service providers.

The Commission, in collaboration with community health resources and local health departments, shall develop a specialty care network for individuals: With family income that does not exceed 200% of the federal poverty level; and Who are referred through a community health resource. The specialty care network shall: Consist of health care practitioners who agree to provide care to individuals referred through a community health resource for a discounted fee established by the Commission; and Include health care practitioners who historically have served the uninsured. Individuals receiving health care through the specialty care network shall pay for specialty care according to a sliding fee scale developed by the Commission. In addition to patient fees, office–based specialty care visits, diagnostic testing, and laboratory tests shall be subsidized by funds provided from: General funds; and Money collected from a nonprofit health maintenance organization in accordance with § 6–121(b)(3) of the Insurance Article. Subject to available funding, the Commission shall provide subsidies to community health resources for office–based specialty care visits, diagnostic testing, and laboratory tests.