HB 78
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
House Bill 78 (Delegate Pena-Melnyk, et al.)
Health and Government Operations Finance
Public Health - Maryland Commission on Health Equity (The Shirley Nathan-
Pulliam Health Equity Act of 2021)
This bill establishes the Maryland Commission on Health Equity to (1) employ a “health
equity framework” in specified examinations; (2) provide advice on issues of racial, ethnic,
cultural, or socioeconomic health disparities; (3) facilitate coordination of expertise and
experience in developing a comprehensive health equity plan addressing the social
determinants of health; and (4) set goals for health equity and prepare a plan for the State
to achieve health equity in alignment with other statewide planning activities. The
commission must establish an advisory committee on data collection. The Maryland
Department of Health (MDH) must staff the commission. The commission must submit an
annual report by December 1 of each year; the 2023 report must include findings and
recommendations on the health effects occurring in the State as a result of specified factors.
Fiscal Summary
State Effect: General fund expenditures increase by at least $64,300 beginning in
FY 2022 to staff the commission, as discussed below. Future year expenditures reflect
annualization and ongoing costs. Revenues are not affected.
(in dollars) FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
Revenues $0 $0 $0 $0 $0
GF Expenditure 64,300 75,400 77,700 80,500 83,300
Net Effect ($64,300) ($75,400) ($77,700) ($80,500) ($83,300)
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: None; participation of a local health department representative does not
materially affect local finances or operations.
Small Business Effect: None.
Analysis
Bill Summary: “Health equity framework” means a public health framework through
which policymakers and stakeholders in the public and private sectors use a collaborative
approach to improve health outcomes and reduce health inequities in Maryland by
incorporating health considerations into decision making across sectors and policy areas.
Duties of the Commission
The commission must (1) examine and make recommendations regarding incorporating
health considerations into decision making, implicit bias training, training on collection of
patient self-identified data, and specified national standards; (2) foster collaboration
between units of government and develop policies to improve health and reduce health
inequities; (3) identify measures for monitoring and advancing health equity in the State;
(4) establish a State plan for achieving health equity in alignment with other statewide
planning activities; and (5) make recommendations and provide advice, as specified.
Membership of the Commission
The commission comprises one member of the Senate; one member of the House of
Delegates; the Secretaries of Aging, Agriculture, Budget and Management, Commerce,
Disabilities, the Environment, General Services, Health, Housing and Community
Development, Human Services, Information Technology, Juvenile Services, Labor,
Natural Resources, Planning, State Police, Transportation, and Veterans Affairs; the
Commissioner of Correction; the State Superintendent of Schools; the Maryland Insurance
Commissioner; a representative of a local health department; and specified additional
representatives from MDH. Members may not receive compensation but are entitled to
reimbursement for expenses under standard State travel regulations. The Governor must
designate the chair from among the members. The commission must meet at least
four times annually.
Advisory Committee on Data Collection
The commission, in coordination with the State-designated health information exchange
(HIE), must establish an advisory committee to make recommendations on data collection,
needs, quality, reporting, evaluation, and visualization.
The advisory committee must define the parameters of a health equity data set to be
maintained by the HIE, including specified indicators. The data set must include data from
health care facilities that report to the Health Services Cost Review Commission, health
care payers that report to the Maryland Health Care Commission, and any other data source
the advisory committee determines necessary. Data must be reported in the aggregate if
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reported to the public or from the HIE to the commission. The commission may request
data consistent with the recommendations of the advisory committee. Such data must be
provided, to the extent authorized by federal and State privacy law, to the commission or
the HIE.
The HIE must participate in the advisory committee and maintain a data set for the
commission consistent with the parameters defined by the advisory committee.
Current Law: Chapters 558 and 559 of 2017 established the Workgroup on Health in All
Policies to study and make recommendations to units of State and local government on
laws and policies that will positively impact the health of residents in the State. The
workgroup, staffed by the University of Maryland School of Public Health, Maryland
Center for Equity (better known as M-CHE) and MDH, was required to submit a report on
its findings and recommendations, as well as draft legislation necessary to carry out the
recommendations, to the Senate Education, Health, and Environmental Affairs Committee
and the House Health and Government Operations Committee; the report was completed
on September 30, 2019. Among other recommendations, the workgroup suggested that a
Health in All Policies Commission be established to develop a Health in All Policies
framework in the State.
For more general information about health disparities in Maryland, see the Appendix –
Health Disparities.
State Expenditures: MDH general fund expenditures increase by at least $64,329 in
fiscal 2022, which accounts for the bill’s October 1, 2021 effective date. The estimate
reflects the cost to hire one full-time health policy analyst to provide staff support to the
commission, coordinate research, and prepare the commission’s required reports. It
includes a salary, fringe benefits, one-time start-up costs, and ongoing operating expenses.
Any additional costs for representatives of State agencies to participate as members of the
commission, including expense reimbursement, can be handled within each respective
agency’s existing budgeted resources. This analysis does not include any additional costs
to convene an advisory committee on data collection, for the HIE to maintain a data set, or
to conduct the research necessary to complete the study that must be included with the
commission’s 2023 annual report.
Position 1.0
Salary and Fringe Benefits $58,748
One-time Start-up and Ongoing Expenses 5,581
FY 2022 Expenditures $64,329
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Future year expenditures reflect a full salary with annual increases and employee turnover
as well as annual increases in ongoing operating expenses.
Additional Information
Prior Introductions: Similar legislation, SB 716 of 2020, received a hearing in the
Senate Finance Committee, but no further action was taken. Its cross file, HB 1528,
received a hearing in the House Health and Government Operations Committee, but no
further action was taken.
Designated Cross File: SB 52 (Senator Washington) - Finance.
Information Source(s): Department of Information Technology; Department of
Commerce; Maryland State Department of Education; Maryland Department of
Agriculture; Department of Budget and Management; Maryland Department of
Disabilities; Department of General Services; Maryland Department of Health;
Department of Housing and Community Development; Department of Human Services;
Department of Juvenile Services; Maryland Department of Labor; Maryland Department
of Planning; Department of Public Safety and Correctional Services; Department of State
Police; Maryland Department of Transportation; Department of Veterans Affairs;
Department of Legislative Services
Fiscal Note History: First Reader - January 22, 2021
rh/ljm Third Reader - April 7, 2021
Revised - Amendment(s) - April 7, 2021
Analysis by: Jennifer B. Chasse Direct Inquiries to:
(410) 946-5510
(301) 970-5510
HB 78/ Page 4
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
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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
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;
taking actions to increase the number of minority health care providers;
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 - Maryland Commission on Health Equity (The Shirley Nathan-Pulliam Health Equity Act of 2021): 4-302.3 Health General, 13-4201 Health General, 13-4202 Health General, 13-4203 Health General, 13-4204 Health General, 13-4205 Health General, 13-4206 Health General, 13-4207 Health General
Text - Third - Public Health - Maryland Commission on Health Equity (The Shirley Nathan-Pulliam Health Equity Act of 2021): 4-302.3 Health General, 13-4201 Health General, 13-4202 Health General, 13-4203 Health General, 13-4204 Health General, 13-4205 Health General, 13-4206 Health General, 13-4207 Health General