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Maryland lawmakers, advocates tout ‘huge wins’ in health legislation. Here’s what passed this year.

After a session largely dominated by mitigating the severity of the coronavirus pandemic and rewriting policing laws in the state, Maryland lawmakers and advocates are highlighting that they also had a “tremendous” year for health care legislation in the General Assembly.

Included among the gains are bills that establish “health equity resource communities” to help eliminate wellness disparities that exist among geographic lines; provide young adults subsidies to enroll in the state’s health insurance program; and preserve telehealth as a viable mechanism for patient care.

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Here’s a rundown of what passed this year in the 2021 legislative session.

Expanded telehealth access

The Preserve Telehealth Access Act of 2021 expands the definition of “telehealth” and the coverage and reimbursement requirements for such health care services.

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It is defined now as the delivery of “medically necessary” health services, including dental and behavioral health, to a patient by a distant-site provider with “technology-assisted communication,” according to a summary of the bill.

Telehealth coverage now includes audio-only telephone conversations, remote patient monitoring services and interactions between patient and provider both in real time and not in real time.

Medical debt protection

A new Maryland bill prohibits liens, arrests and body attachments for patients experiencing medical debt. All patients would qualify for income-based repayment plans, not just those from low-income backgrounds. And there would be a 180-day period before hospitals or debt collectors could file for an action to collect debt.

The state will require providers to issue refunds to patients for billing mistakes within 240 days, an improvement over existing deadlines.

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The bill requires hospitals to submit an annual report to the state’s Health Services Cost Review Commission on the hospital’s debt collection activity to be publicly posted on the commission’s website.

Young adult health insurance subsidies

This bill requires the Maryland Health Benefit Exchange to establish a pilot program that provides subsidies for young adults, ages 18 to 40, to enroll in plans in the individual health insurance market. Those who qualify earn between 133% and 400% of the federal poverty level, or an annual income ranging from about $17,130 to $51,520.

This would keep health insurance premiums low and ensure that all Marylanders can get the coverage they need, said state Sen. Brian Feldman during a virtual event Thursday with other legislators and health equity advocates.

Feldman sponsored the Senate bill, which provides $20 million in annual subsidies for fiscal year 2022 and 2023.

Insurance revisions/special enrollment period

During the coronavirus pandemic, a record number of Marylanders filed for unemployment insurance benefits as thousands lost their jobs. State lawmakers said they recognized how many state workers received health care benefits through their employers, and how many were left uncovered as a result of their job loss.

With a new bill, people who file for unemployment benefits will have the option to connect with the Maryland Health Benefit Exchange.

After they elect to connect, the Maryland Health Benefit Exchange will review the person’s eligibility for free or low-cost health insurance, and then help the individual enroll.

Maternal Medicaid eligibility

Pregnant women with family incomes up to 250% of the federal poverty level can now receive full Medicaid coverage, including dental and behavioral health care, for the duration of pregnancy as well as 12 months after.

In Maryland, current law provides Medicaid coverage to pregnant women for 60 days postpartum. The American Rescue Plan Act passed by Congress this year establishes a new state option to increase postpartum coverage to 12 months.

Health equity resources communities

Supported by a wide range of elected officials and lawmakers, as well as by Johns Hopkins University and Medicine, the health equity resource communities bill builds off a previous pilot program that created five health “enterprise zones” using money from the state’s general fund. Those zones received targeted funds to reduce health disparities in areas determined to be in need of more health care services and resources.

The bill specifies that the Maryland Community Health Resources Commission must award grant funding to applicants for the purpose of improving health outcomes, such as by enhancing access to primary care, promoting primary and secondary prevention services, and reducing health care costs and hospital admissions and readmissions.

Applicants from previously designated enterprise zones will receive special consideration for grant funding, according to a summary of the bill.

The original proposal sought to fund this item with a 1 percentage point increase in the state’s alcohol tax, boosting it to 10% from 9%. The legislature opposed this funding mechanism, and instead will provide funds through the state’s pandemic RELIEF Act and its reinsurance fund. The program will receive about $59 million over five years.

After the five-year mark, the program will not “sunset” as the pilot program did, said Vincent DeMarco, the president of the lobbying group Maryland Citizens’ Health Initiative. Instead, it will need a fresh boost of funding that he said he’s confident lawmakers will source and secure.

Shirley Nathan-Pulliam Health Equity Act

Named in honor of former state Sen. Shirley Nathan-Pulliam, a longtime advocate of health equity, the Maryland Commission on Health Equity would be staffed with lawmakers, agency heads, health department representatives and commissioners, and required to submit an annual report each year with findings and recommendations related to disparities in health and health care.

The commission would collect data and offer insights to state agencies and lawmakers as to how to incorporate health considerations into legislation and policies. It also would create a comprehensive health equity plan for the state.

The bill creates a framework, and a lens, through which the state can examine policies with a focus on eliminating health disparities and inequitable outcomes for people of color, who often have less access to health care and worse outcomes relative to white people.

Other health equity legislation

Starting April 1, 2022, health care providers who wish to renew their licenses or certificates must enroll in implicit-bias training as a condition of renewal in an effort to eliminate mistrust of medical professionals in communities of color, which often report higher levels of discomfort at doctor’s offices and tend to have worse health outcomes and higher levels of maternal and infant mortality than white communities.

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The state will be required to fund an Office of Minority Health and Health Disparities that must publish every six months health data that includes race and ethnicity information it collects on its website.

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