HB 309
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader
House Bill 309 (Delegates Pena-Melnyk and R. Lewis)
Health and Government Operations Education, Health, and Environmental Affairs
Public Health - Data - Race and Ethnicity Information
This bill requires the Director of the Office of Minority Health and Health Disparities
(OMHHD) to meet with representatives from the Maryland Health Care Commission
(MHCC) and the Maryland Department of Health (MDH) at least annually to examine the
collection of health data that includes race and ethnicity information in the State and
identify any changes for improving such data that is accessible by OMHHD. OMHHD
must, to the extent authorized under federal and State privacy laws, respond to requests for
health data that includes race and ethnicity information within 30 days after receipt of the
request. By January 1, 2022, OMHHD, in coordination with MHCC and MDH, must
establish, submit to the General Assembly, and implement a specified data plan. The bill
also alters the Health Care Disparities Policy Report Card published by OMHHD and
requires each health occupations board to include on application and renewal forms an
option for the applicant to provide their race and ethnicity information and encourage
provision of such information.
Fiscal Summary
State Effect: The bill’s requirements can likely be handled with existing budgeted
resources, as discussed below. Revenues are not affected.
Local Effect: None.
Small Business Effect: None.
Analysis
Bill Summary: OMHHD must collaborate with the health occupations boards in
publishing the Health Care Disparities Policy Report Card that must include the racial and
ethnic composition of all individuals who hold a license or certificate issued by a health
occupations board compared to the racial and ethnic composition of the State’s population.
The required data plan must be for (1) improving the collection of health data that includes
race and ethnicity information in the State; (2) ensuring that OMHHD has access to
up-to-date health data that includes race and ethnicity information; (3) to the extent
authorized under federal and State privacy laws, posting health data that includes race and
ethnicity information on OMHHD’s website; and (4) updating the data on the website at
least once every six months.
Current Law: Among other duties, OMHHD must, in collaboration with MHCC, publish
annually on the MDH website and provide in writing on request a Health Care Disparities
Policy Report Card that includes (1) an analysis of racial and ethnic variations in insurance
coverage for low-income, nonelderly individuals; (2) the racial and ethnic composition of
the physician population compared to the racial and ethnic composition of the State’s
population; and (3) the racial and ethnic disparities in morbidity and mortality rates for
cardiovascular disease, cancer, diabetes, HIV/AIDS, infant mortality, asthma, and other
diseases identified by MHCC.
For additional information on health disparities in Maryland, please see Appendix –
Health Disparities.
State Expenditures: OMHHD is currently required, among other duties, to collect and
analyze relevant data; serve as a clearinghouse for information about health disparities
data; and, in collaboration with MHCC, publish an annual report card. (However, the
Department of Legislative Services notes that a report card was last produced in 2010.)
OMHHD staff includes a part-time (75%) epidemiologist. Thus, this analysis assumes that
OMHHD can expand any future report card to include information on the racial and ethnic
composition of all health occupations, respond to requests for data within 30 days of
request, meet at least annually with MHCC and MDH to examine data collection efforts
and identify changes for improvement, and submit and implement a data plan as required
under the bill using existing budgeted resources. To the extent additional assistance is
required, MDH general fund expenditures increase to provide contractual assistance.
The health occupations boards currently collect race and ethnicity information on
applicants for statistical purposes, although provision of such information is typically
voluntary. Thus, the boards can submit available information on the racial and ethnic
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composition of various health occupations to OMHHD for inclusion in a report card using
existing budgeted resources.
Additional Information
Prior Introductions: None.
Designated Cross File: SB 565 (Senator Griffith, et al.) - Education, Health, and
Environmental Affairs.
Information Source(s): Maryland Department of Health; Department of Legislative
Services
Fiscal Note History: First Reader - January 22, 2021
rh/ljm Third Reader - March 16, 2021
Analysis by: Jennifer B. Chasse Direct Inquiries to:
(410) 946-5510
(301) 970-5510
HB 309/ Page 3
Appendix – Health Disparities
Racial and ethnic minorities are more likely to experience poor health outcomes as a
consequence of their social determinants of health, including access to health care,
education, employment, economic stability, housing, public safety, and neighborhood and
environmental factors. A broad body of research has quantified the existence of health
disparities between Black, Hispanic, and Native American individuals and their White
counterparts, including a greater risk of heart disease, stroke, infant mortality, maternal
mortality, lower birth weight, obesity, hypertension, type 2 diabetes, cancers, respiratory
diseases, and autoimmune diseases.
Health Disparities in Maryland
Data consistently shows ongoing and in some cases growing health disparities in Maryland,
including the impact of COVID-19, maternal and infant mortality, incidence of HIV, and
emergency room (ER) visits for substance use, asthma, diabetes, and hypertension. For
example:
While Black individuals comprise 29.8% of the Maryland population, they represent
36% of COVID-19 deaths as of January 18, 2021.
Maryland’s maternal mortality rate for Black women is 3.7 times that of
White women, and the racial disparity has widened in recent years.
Maryland’s infant mortality rate for all races/ethnicities has remained level but
remains highest (10.2 per 1,000 in 2018) among the Black non-Hispanic population,
nearly 2.5 times higher than the rate for the White non-Hispanic population.
The incidence of HIV for all races/ethnicities has generally declined in Maryland;
although the incidence among the Black non-Hispanic population
(49.0 per 100,000) remains 2.4 times that of the total population.
In 2017, ER visits for the Black non-Hispanic population compared with all
races/ethnicities were 50% higher for substance use disorder; nearly 200% higher
for asthma-related ER visits; 86% higher for diabetes-related ER visits; and
89% higher for hypertension-related ER visits.
Maryland Office of Minority Health and Health Disparities
A central effort to address health disparities in Maryland was the establishment of the
Office of Minority Health and Health Disparities (OMHHD) in the Maryland Department
of Health (MDH) in 2004. The purpose of the office is to address social determinants of
health and eliminate health disparities by leveraging resources, providing health equity
consultation, impacting external communications, guiding policy decisions, and
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influencing strategic direction on behalf of the Secretary of Health. The office provides
grants and technical assistance to community-based organizations, collects data on race
and ethnicity, and targets programs and initiatives to three health conditions that
disproportionately impact minorities in Maryland: infant mortality, asthma, and
diabetes/prediabetes. The office’s Minority Outreach and Technical Assistance Program
provides grant funding for activities such as coordination and navigation of health care
services, access to community-based health education, linkage to health insurance
enrollment and social services, and self-management support through home visiting. In
2006 and 2010, the office prepared a Maryland Plan to Eliminate Minority Health
Disparities.
Other Major Efforts to Address Health Disparities Since 2004
In January 2010, the Maryland Health Care Commission (MHCC) and OMHHD produced
a Health Care Disparities Policy Report Card. The report card examined racial and ethnic
distribution of Maryland physicians compared to the Maryland population and found that
Black/African American, Hispanic/Latino, and American Indians/Native Americans were
underrepresented in the physician workforce and in graduating classes from Maryland
medical schools.
Other legislative efforts to address health disparities have focused on workforce
development for health care providers, including convening a Workgroup on Cultural
Competency and Workforce Development for Mental Health Professionals; establishing a
Cultural and Linguistic Health Care Provider Competency Program; facilitating the
workforce development, training, and certification of community health workers; requiring
health occupations boards to report on efforts to educate regulated individuals regarding
reducing and eliminating racial and ethnic disparities, improving health literacy, improving
cultural and linguistic competency, and achieving racial and ethnic health equity; and
requiring evidence-based implicit bias training for perinatal health care professionals.
In recent years, legislative initiatives regarding health disparities have focused on maternal
and child health, including requiring a study on the mortality rates of African American
infants and infants in rural areas, requiring MDH to establish a Maternal Mortality
Stakeholder Group to examine issues resulting in disparities in maternal deaths, and
requiring the Maternal Mortality Review Program to make recommendations to reduce
disparities in the maternal mortality rate (including recommendations related to social
determinants of health) and to include information on racial disparities in its annual report.
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Senate President’s Advisory Workgroup on Equity and Inclusion
In August 2020, the President of the Senate appointed a Senate workgroup to address
environmental justice, health care disparities, and wealth and economic opportunity for
minority Marylanders. The workgroup issued a report in January 2021, which includes
recommendations relating to health disparities, including:
requiring the director of OMHHD to meet with MHCC and MDH at least
once annually to examine the collection of health data that includes race and
ethnicity information and identify any changes for improving such data;
requiring OMHHD to prepare an updated plan to eliminate minority health
disparities and requiring MHCC to prepare a revised health care disparities policy
report card;
extending Medicaid coverage for pregnant women until 12 months postpartum and
providing care coordination and health literacy education for individuals as they
transition from Medicaid coverage;
establishing a standing Maternal and Child Health Committee in MDH to develop
a Blueprint for Maternal and Child Health;
ensuring that all pregnant women receive comprehensive prenatal care by increasing
awareness of and access to resources for all women, including establishing an
emergency program that covers prenatal care for undocumented immigrants;
assessing certified nurse midwife privileges in Maryland hospitals and developing
recommendations with major stakeholders;
establishing a Medicaid Doula Pilot Program in two counties;
requiring the Cultural and Linguistic Health Care Professional Competency
Program to identify and approve implicit bias training programs for all individuals
licensed and certified under the Health Occupations Article; and
reestablishing the five health enterprise zones permanently.
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Statutes affected: Text - First - Public Health - Data - Race and Ethnicity Information: 20-1004 Health Occupations, 20-1005 Health Occupations, 1-225 Health Occupations
Text - Third - Public Health - Data - Race and Ethnicity Information: 20-1004 Health General, 20-1005 Health General, 1-225 Health Occupations