On Health Care - New Maryland health care legislation

Although there were no new blockbuster health care bills passed during the 2004 session of the Maryland General Assembly, Maryland's legislature was, nevertheless, busy addressing issues ranging from umbilical cords to obesity, from podiatrists to the CareFirst executive suite, and from the legibility of physician handwriting to the uninsured.

Podiatrist Reimbursement. If an insurer, nonprofit health plan or HMO reimburses a service that is within the lawful scope of practice of a licensed podiatrist, it must reimburse the same amount for that service regardless of whether the service is performed by a physician or a licensed podiatrist.

However, the carrier is not prohibited from determining the reimbursement based on geographic location of the service or the preeminent qualifications of the physician/podiatrist.

This applies to all policies issued for delivery or renewed on or after Oct. 1, 2004.

Patient's Plan of Care. The office of the attorney general must develop a patient's plan of care form that will summarize the patient's wishes regarding the use of life-sustaining measures and regarding the transfer of the individual to a hospital from a non- hospital setting.

The plan of care is voluntary, may be rescinded at any time and must be consistent with any advance directive executed by the patient.

Health care providers must review this form as part of a patient's plan of care.

Also, health care facilities must offer an individual upon admission, the opportunity to prepare a plan of care and, if executed, the facility must keep the form in the front of a resident's medical records.

This legislation is effective Oct. 1, 2004.

Small Group Market - Limited Benefit Plan. The Maryland Health Care Commission must develop a limited health benefit plan for businesses that have 50 or fewer employees.

The starting date for the new plan is July 1, 2005.

The benefits under the plan cannot exceed 70 percent of the actuarial value of the HCC's existing Comprehensive Standard Benefit Plan for the small group market.

Each carrier with at least 10 percent of the total lives insured in the small group market must offer the limited plan to a small employer that has not provided the CSBP in the last 12 months and whose employees are paid an average annual wage not exceeding 75 percent of the average annual wage in the state.

The limited benefit plan will sunset June 30, 2008.

Obesity. Health insurance carriers that cover the surgical treatment of morbid obesity may require an insured to satisfy guidelines approved by the National Institutes of Health for the long- term reversal of morbid obesity.

A new task force is also established to review the utilization review procedures currently used by carriers providing surgical treatment for morbid obesity.

By Dec. 1, 2004, the task force will review the NIH guidelines, recommend a set of criteria appropriate for the utilization review of the procedure and establish procedures for documenting patient compliance with the criteria.

The legislation is effective June 1, 2004, for one year.

Nursing Home Services at Home. If a nursing home resident expresses an interest in obtaining nursing services in his or her community, a nursing home must refer the resident to the Department of Health and Mental Hygiene or its designee for additional information and possible placement in a community-based setting.

DHMH must provide the resident with information regarding home and community-based services, including services under a Medicaid waiver. Effective July 1, 2004.

Legibility of Prescriptions. The secretary of Health and Mental Hygiene must convene a workgroup of health care professionals who are to recommend statutory or regulatory changes, if any, that are needed to improve prescription legibility and thereby enhance patient safety.

The workgroup's recommendations are due on or before Nov. 1, 2004.

Medicaid Mental Health Services. Without legislative approval, the secretary of Health and Mental Hygiene may not end the exclusion of specialty mental health services from the Medicaid HealthChoice managed care program.

Additionally, DHMH may not contract with a behavioral managed care organization to provide specialty mental health services. Effective June 1, 2004.

Umbilical Cord Blood. Hospitals must permit pregnant patients to make arrangements for the donation of the blood from the umbilical cord of a newborn child to a certified umbilical cord blood bank.

A patient who arranges for the donation may not be charged for the costs associated with the donation.

Hospital personnel may not be required to collect the blood if such action is contrary to their religious beliefs.

Effective Oct. 1, 2004.

Nonprofit Health Plan Compensation Guidelines. The Maryland Insurance Commissioner's authority to approve compensation guidelines for all officers/executives of a nonprofit health plan has been repealed.

Instead, the nonprofit health service plan must provide the commissioner with a board-approved copy of its compensation guidelines on or before Sept. 1.

This legislation is retroactive to June 6, 2003.

Barry F. Rosen is the chairman and CEO of the law firm of Gordon, Feinblatt, Rothman, Hoffberger & Hollander LLC, and he can be reached at 410-576-4224 or brosen@gfrlaw.com. Lynn S. Slawson, a paralegal in Gordon, Feinblatt's Health Care Practice Group, contributed to this article.

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