By Christopher P. Dean*
December 18, 2008
The Maryland General Assembly will not convene until January 14, 2009. Below is a preview for 2009 and a summary of recent legislation from the previous general and special sessions.
The 426th Session of the Maryland General Assembly will convene on January 14, 2009, and conclude its ninety-day general session on April 13, 2009. The upcoming session will be affected by the economic downturn as state budget officials' estimates range from a $700 million to $1 billion tax revenue shortfall for the current fiscal year ending on June 30, 2009. Maryland's constitution does not permit budget deficits.
Legislators in the upcoming session will likely scrutinize healthcare initiatives requiring new funding or increased funding from fiscal year 2008. The most visible healthcare initiative in 2009 is a $15 billion plan to provide universal health insurance for all Marylanders.
During the 2008 general session and a special session that ended in November 2007, Maryland lawmakers focused on a variety of healthcare issues, including: (1) expanding healthcare access for some of the 800,000 uninsured Marylanders, (2) healthcare rights of domestic partners, (3) reducing delays in reimbursements for new physicians,
(4) new requirements for pharmacy benefit managers, and (5) a task force to review the disciplinary process for healthcare licensees in Maryland.
I. Expanding Access
Public–private partnerships may now jointly fund and provide healthcare coverage in Maryland. As a result of new legislation passed in 2008, Howard County debuted its Healthy Howard Access Plan, which is a public–private initiative that provides healthcare coverage to uninsured families that live in Howard County and have incomes up to 300% of the federal poverty guidelines. The County expected to provide healthcare coverage to approximately 2,000 of the County's 20,000 uninsured residents in its first year and planned to expand the program in the future.
The General Assembly also created the Maryland Insurance Partnership to subsidize healthcare insurance costs of small business with more than two and less than nine employees. The Partnership received $15 million in funding and was designed to subsidize the cost of insuring approximately 10,000–15,000 uninsured employees.
Medical Assistance Program—Maryland's version of Medicaid—eligibility was increased to 116% of the federal poverty guideline for parents and caretaker relatives with a dependent child living in the home. This increased eligibility was projected to allow an additional 90,000 residents to enroll in the Medical Assistance Program.
II. Domestic Partners
In regard to domestic partners, individuals who comply with the statute's definition of a domestic partnership have certain visitation and medical decision-making rights in the healthcare arena. Hospitals, nursing homes, and residential treatment centers must allow visitation by a patient's domestic partner, the children of the domestic partner, and the domestic partner of the patient's parent or child to visit, unless (a) no visitors are allowed, (b) the facility reasonably determines that the presence of the visitor will endanger the health of the patient, or (c) if the patient or patient's representative states that a particular person should not visit.
Two adults are to be treated as domestic partners if one of the adults, in good faith, tells an emergency medical provider that the adults are in a mutually interdependent relationship solely for the purposes of allowing one adult to accompany the ill adult to a hospital and for visiting the ill adult who has been admitted to the hospital for an emergency. In addition, a domestic partner may make healthcare decisions for a person who has been certified to be incapable of making an informed decision, and who has not appointed a healthcare agent or whose healthcare agent/guardian is unavailable.
III. Physician Reimbursement
For physician reimbursement, health benefit plans must reimburse already participating group practices for services provided by newly employed physicians while the health benefit plan is reviewing the new physician's credentialing application. This reimbursement period begins when the group receives notice from the carrier that the application is being processed, but ends if the carrier ultimately rejects the new physician. Previously, credentialing a new physician could take ninety days or more. As a condition for reimbursement, the new physician must be licensed in Maryland, and either have professional liability insurance or have been credentialed by an accredited hospital.
IV. Pharmacy Benefit Managers
Effective October 1, 2008, pharmacy benefit managers (PBMs) must register with the Maryland Insurance Commissioner. In addition, a PBM may only request a change from one prescription drug to another if it is for a medical reason that will benefit the beneficiary or will result in financial benefits to the health plan or beneficiary; however, this prohibition does not apply to a generic substitution. Before contracting with a health plan, a PBM will also have to tell the health plan that the PBM may solicit/receive manufacturer payments, pass through or retain manufacturer payments, or sell or share aggregate utilization information.
V. Task Force for Licensees
Lastly, a new task force was created to review the discipline of licensed healthcare professionals in Maryland. Currently, each licensing board has disciplinary authority over its respective licensees without central guidance over their respective disciplinary processes. The task force will make recommendations to the General Assembly regarding a centralized process, due process issues for the licensees, standardized disciplinary guidelines, and improving public access to disciplinary decisions.
*We would like to thank Christopher P. Dean, Esquire (Gordon Feinblatt Rothman Hoffberger & Hollander LLC, Baltimore, MD) for providing this summary.