In this subtitle the following words have the meanings indicated. “Advisory Committee” means the Health Equity Resource Community Advisory Committee. “Commission” means the Community Health Resources Commission. “Community health worker” has the meaning stated in § 13–3701 of this article. “Federally qualified health center” has the meaning stated in § 24–1301 of this article. “Fund” means the Health Equity Resource Community Reserve Fund established under § 20–1407 of this subtitle. “Health care practitioner” means an individual or, collectively, a group of individuals working together within the same practice, each of whom is licensed, certified, or otherwise authorized by law to provide health care services under the Health Occupations Article. “Health disparity” means a particular type of health difference, such as a difference in rates of hypertension, heart disease, asthma, diabetes, substance abuse, mental health disorders, and maternal and infant mortality, that: Is closely linked with social, economic, or environmental disadvantage; and Adversely affects groups of individuals who have systematically experienced greater obstacles to health care based on their: Race or ethnicity; Religion; Socioeconomic status; Gender, gender identity, or sexual orientation; Age; Mental health status; Cognitive, sensory, or physical disability; Geographic location; or Other characteristic historically linked to discrimination or exclusion. “Health Equity Resource Community” means a contiguous geographic area that: Demonstrates measurable and documented health disparities and poor health outcomes; Is small enough to allow for the incentives offered under this subtitle to have a significant impact on improving health outcomes and reducing health disparities, including racial, ethnic, geographic, and disability related health disparities; Is designated by the Commission in accordance with the provisions of this subtitle; and Has a minimum population of 5,000 residents. “Hospital” has the meaning stated in § 19–301 of this article. “Institution of higher education” has the meaning stated in § 10–101 of the Education Article.

The purpose of establishing Health Equity Resource Communities is to target State resources to specific areas of the State to: Reduce health disparities; Improve health outcomes; Improve access to primary care; Promote primary and secondary prevention services; and Reduce health care costs and hospital admissions and readmissions. The Commission may adopt regulations to carry out the provisions of this subtitle and to specify eligibility criteria and application, approval, and monitoring processes for the resources allocated under this subtitle. The Office of Minority Health and Health Disparities and the Chesapeake Regional Information System for our Patients (CRISP) shall provide technical assistance to the Commission in implementing the provisions of this subtitle. At the request of the Commission, any other unit in the Department shall provide technical assistance to the Commission in implementing the provisions of this subtitle. Two additional staff shall be added to the Commission to carry out the provisions of this subtitle.

On or before July 1, 2021, the Commission shall establish a Health Equity Resource Community Advisory Committee. The duties of the Advisory Committee include: Providing initial and ongoing assistance and guidance regarding program evaluation and data collection metrics for Health Equity Resource Communities and health equity research practitioners; Assisting the Commission in preparing the required annual report described in § 20–1408(b) of this subtitle and § 19–2112 of this article; Proposing strategies for tax incentives and loan repayments to assist Health Equity Resource Communities in achieving their mission; and Providing guidance, as determined by the Commission, to the Commission as necessary to implement the provisions of this subtitle. The Advisory Committee consists of: The Chair of the Community Health Resources Commission or the Chair’s designee; The Director of the Office of Minority Health and Health Disparities, or the Director’s designee; Three members appointed by the Governor, including: One individual representing the Maryland Department of Health; and One individual with expertise in health care financing; Three members appointed by the President of the Senate, including: One individual with expertise in the social determinants of health; and One individual who is a member of the general public residing in an area that has been or may be designated a Health Equity Resource Community; and Three members appointed by the Speaker of the House, including: One individual with expertise in health equity; and One individual who is a member of the general public residing in an area that has been or may be designated a Health Equity Resource Community. Collectively, the members of the Advisory Committee shall have knowledge of the following: Existing or potential health disparities in the State; Groups of residents negatively affected by health disparities; Systems, policies, and methods likely to improve health outcomes and reduce health disparities; Effective prevention services; Health care costs, trends, and drivers; Clinical health services research; Consumer or patient perspectives; and Innovative ways to address social determinants of health through the use of community health workers. To the extent practicable and consistent with federal and State law, the membership of the Advisory Committee shall reflect the racial, ethnic, geographic, and gender diversity of the State. The Chair of the Maryland Community Health Resources Commission shall chair the Advisory Committee. The term of a member of the Advisory Committee is 4 years. The Commission shall stagger the terms of the initial appointed members. 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 remainder of that term and until a successor is appointed and qualifies. The Commission may remove an appointed member for incompetence, misconduct, or failure to perform the duties of the position. A member of the Advisory Committee: May not receive compensation as a member of the Advisory Committee; but Is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget. The Advisory Committee shall: On or before January 1, 2022, hold an initial meeting; and Meet at least once every 6 months thereafter. The Commission may convene working or advisory groups to facilitate the implementation of this subtitle that shall include individuals who reside in an area that has been or may be designated as a Health Equity Resource Community.

For an area to receive a designation as a Health Equity Resource Community, a nonprofit community–based organization, a nonprofit hospital, an institution of higher education, a federally qualified health center, or a local government agency shall: Apply to the Commission on behalf of the area to receive the designation; and Include federally qualified health centers or other community–based organizations to provide health or wraparound support services within the Health Equity Resource Community. Subject to subsections (c) and (e) of this section, the application shall be in the form and manner and contain the information that the Commission requires. The application shall contain an effective and sustainable plan to reduce health disparities, reduce costs or produce savings to the health care system, and improve health outcomes. The application shall include: A description of how the plan will expand federally qualified health centers’ or other community–based organizations’ capacity to provide health care services or wraparound services to address social determinants of health; and A description of how funding available under this subtitle will be used to address health disparities through evidence–based, cross–sector strategies that may include: Building health care provider capacity; Improving health services delivery; Effectuating community improvements; Conducting outreach and education efforts; Implementing systemic strategies to improve coordination and communication across organizations that provide health care services; Supporting community leadership development efforts; Facilitating policy interventions to address upstream determinants of health; and Implementing scalable approaches to meet the nonmedical social needs of populations identified in the most recent community health needs assessment, such as unstable housing, inadequate food, or job development. The application may include: A proposal to use funding available under this subtitle to provide for loan repayment incentives to induce health care practitioners to practice in the area; A proposal to use innovative public health strategies to reduce health disparities in the area that may be supported by grants awarded under this subtitle, such as the use of community health workers, community health centers, federally qualified health centers, institutions of higher education, and community–based disease management activities; and A proposal to use other incentives or mechanisms to address health disparities that focus on ways to expand access to care, expand access to nonmedical interventions that promote improved health outcomes, promote hiring, and reduce costs to the health care system. The application submitted in accordance with this section shall allocate sufficient funding to cover salary and benefit costs for the evaluator required under § 20–1406 of this subtitle.

On or before October 1, 2023, the Commission shall issue a request for proposals to designate areas as Health Equity Resource Communities in accordance with this subtitle. The Commission: Shall consider geographic diversity, among other factors, when designating areas as Health Equity Resource Communities; and May conduct outreach efforts to facilitate a geographically diverse pool of applicants, including efforts to facilitate submission of applications from rural areas. After receiving all applications submitted to the Commission, the Commission 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 the names of applicants and geographic areas in which applicants are located. The Commission shall give priority to applications that demonstrate: Support from and participation of key stakeholders in the public and private sectors, including residents of the area and local government; A plan for long–term funding and self–sustainability; Inclusion of supporting funds from the private sector; Integration with the State Health Improvement Process and the goals set out in the strategic plan of the local health improvement coalition; A plan for evaluation of the impact of designation of the proposed area as a Health Equity Resource Community and strategies for quality improvement; Other factors that the Commission determines are appropriate to demonstrate a commitment to reduce health disparities and improve health outcomes; and A previous designation as a Health Enterprise Zone or inclusion of areas previously included in a Health Enterprise Zone. An application for designation of an area as a Health Equity Resource Community submitted by a nonprofit community–based organization, a nonprofit hospital, an institution of higher education, a federally qualified health center, or a local government agency shall provide for the employment and supervision of employment of one full–time employee to serve as an evaluator of the operation, impact, and effectiveness of the Health Equity Resource Community designated under this subtitle. To be designated as an evaluator under this subsection, the employee must demonstrate experience in methods of qualitative and quantitative research methodology. An employee designated as an evaluator under this subsection shall coordinate with the Commission to: Monitor the operation, effectiveness, and impact of the Health Equity Resource Community; and Provide data, statistics, and analysis to the Commission that shall address the reporting elements specified under § 20–1408(b) of this subtitle. Notwithstanding the requirement to hire a full–time employee to serve as an evaluator under subsection (c) of this section, a nonprofit community–based organization, a nonprofit hospital, an institution of higher education, a federally qualified health center, or a local government agency may contract with a historically black college or university in the State to provide evaluator services. The decision of the Commission to designate an area as a Health Equity Resource Community shall be a final decision. A designation by the Commission of an area as a Health Equity Resource Community shall have a term of 5 years and may be renewed in accordance with an application approved by the Commission.

Health care practitioners and community health workers that practice in a Health Equity Resource Community may receive loan repayment assistance, as provided for in the application for designation for the Health Equity Resource Community and approved by the Commission under this subtitle. A health care practitioner or community health worker may apply to the Commission for a grant to defray the costs of capital or leasehold improvements to, or medical or dental equipment to be used in, a Health Equity Resource Community. To qualify for a grant under paragraph (1) of this subsection, a health care practitioner or a community health worker shall: Own or lease the health care facility; and Provide health care from that facility. A grant to defray the cost of medical or dental equipment may not exceed the lesser of $25,000 or 50% of the cost of the equipment. Grants for capital or leasehold improvements shall be for the purposes of improving or expanding the delivery of health care in the Health Equity Resource Community. A nonprofit community–based organization, a nonprofit hospital, an institution of higher education, a federally qualified health center, or a local government agency that receives approval of an application submitted under § 20–1403 of this subtitle may submit an application, on its own behalf, to receive grants for capital or leasehold improvements, as determined by the Commission, for the purposes described under subsection (b)(3)(ii) of this section. Subject to § 20–1408(a)(2) of this subtitle, the term of any grant awarded to a nonprofit community–based organization, a nonprofit hospital, an institution of higher education, a federally qualified health center, or a local government agency for capital or leasehold improvements shall have a term of 5 years, and may be renewed in accordance with an application approved by the Commission.

There is a Health Equity Resource Community Reserve Fund. The purpose of the Fund is to: Support areas designated by the Commission as Health Equity Resource Communities by providing grants to community–based organizations, nonprofit hospitals, institutions of higher education, federally qualified health centers, local government agencies, health care practitioners, and community health workers to facilitate reduction of health disparities, improve health outcomes, provide drug treatment and rehabilitation, and reduce health costs and hospital admissions and readmissions in specific areas of the State; and Provide funding to supplement and not supplant existing funding for behavioral health programs that provide prevention, recovery support, and harm reduction services for individuals with substance use and mental health disorders. The Commission shall administer the Fund. The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article. Any unspent portion of the Fund may not be transferred or revert to the General Fund but shall remain in the Fund to be used for the purposes specified in this subtitle. The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund. The Fund consists of: Money appropriated in the State budget to the Fund in accordance with § 31–107 of the Insurance Article; Interest earnings of the Fund; and Any other money from any other source accepted for the benefit of the Fund. Except as provided in paragraph (2) of this subsection, the Fund may be used only to provide funding to the Commission for the support of areas designated as Health Equity Resource Communities by providing grants to community–based organizations, nonprofit hospitals, institutions of higher education, local government agencies, health care practitioners, federally qualified health centers, and community health workers to reduce health disparities, improve health outcomes, provide addiction and mental health services, and reduce health costs and hospital admissions and readmissions. The Fund may be used for the purpose of funding one full–time staff position under § 19–2112(a)(4) of this article and two full–time staff positions under § 20–1402(c) of this subtitle on the Commission. In fiscal year 2024 and each fiscal year thereafter, the Fund may be used to pay for the costs incurred by the Chesapeake Regional Information System for our Patients (CRISP) in providing technical assistance to the Commission. The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested. Any interest earnings of the Fund shall be credited to the Fund. Expenditures from the Fund may be made only in accordance with the State budget. Money expended from the Fund to support areas designated by the Commission as Health Equity Resource Communities under this subtitle is supplemental to and not intended to supplant funding that otherwise would be appropriated for those purposes.

Each nonprofit community–based organization, nonprofit hospital, institution of higher education, federally qualified health center, or local government agency that has submitted a successful application for designation of an area as a Health Equity Resource Community under § 20–1403 of this subtitle shall submit to the Commission a report that includes: A description of progress made toward the objectives set forth in the application; A description of objectives to be met during the immediately following year; and Any other information as requested by the Commission. The reporting required under paragraph (1) of this subsection shall be submitted periodically in accordance with a schedule determined by the Commission. The Commission may revoke a designation of an area as a Health Equity Resource Community if the nonprofit community–based organization, nonprofit hospital, institution of higher education, federally qualified health center, or local government agency that has submitted a successful application for designation of an area as a Health Equity Resource Community fails to meet the objectives provided to the Commission under subsection (a)(1) of this section for a given year. On or before December 15 each year, the Commission shall submit to the Governor and, in accordance with § 2–1257 of the State Government Article, the General Assembly a report that includes: The number and types of incentives granted in each Health Equity Resource Community; Evidence of the impact of the loan repayment incentives in attracting health care practitioners and community health workers to Health Equity Resource Communities; Evidence of the impact of the incentives offered in Health Equity Resource Communities in reducing health disparities and improving health outcomes; and Evidence of the progress in reducing health costs and hospital admissions and readmissions in Health Equity Resource Communities. The report described in paragraph (1) of this subsection shall include data disaggregated by the following: Race; Ethnicity; Primary language; Gender; Socioeconomic status; and Zip code.