HB 836
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
House Bill 836 (Delegate Pena-Melnyk)
Health and Government Operations and Finance
Appropriations
COVID-19 Testing, Contact Tracing, and Vaccination Act of 2021
This emergency bill requires the Maryland Department of Health (MDH), in collaboration
with local health departments (LHDs) and the Maryland State Department of Education
(MSDE), to adopt and implement a two-year plan to respond to COVID-19 by
June 1, 2021. The plan must include specified measures. MDH must also develop and
submit a comprehensive COVID-19 vaccination plan and convene a Maryland Public
Health Modernization Workgroup. MDH must provide specified funding to local
jurisdictions, assisted living programs, home health agencies, and nursing homes. Each
assisted living program, home health agency, nursing home, and specified institutions of
higher education must adopt and implement a specified COVID-19 plan. The bill also
mandates health insurance coverage of COVID-19 testing and administration without
cost-sharing. Any funding appropriated under the bill may consist only of specified federal
funds. Provisions relating to specified COVID-19 testing/infection control plans,
additional funding for nursing homes, and insurance terminate December 31, 2022.
Fiscal Summary
State Effect: Federal fund expenditures of at least $54.5 million are required in FY 2021,
with at least another $98.0 million required in FY 2022 to provide funding to local
jurisdictions and specified facilities. As discussed below, this funding would have been
expended otherwise, likely by MDH, but the timing, distribution, and specific purposes may
have been different in the absence of the bill. Minimal increase in special fund revenues for
the Maryland Insurance Administration (MIA) from filing fees in FY 2021 and 2023; MIA
special fund contractual expenditures increase in FY 2021 and 2023.
Local Effect: Local revenues and expenditures increase by at least $40.0 million in both
FY 2021 and 2022, as discussed below. Some portion of this funding would have likely
been provided absent the bill, but specific purposes, distribution, and timing may have been
different. Additional impacts are possible, as discussed below.
Small Business Effect: Meaningful.
Analysis
Bill Summary: “COVID-19 test” means an in vitro diagnostic test for the detection of
SARS-CoV-2 or the diagnosis of the virus that causes COVID-19, as described in the
federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Components of the Two-year Plan
The two-year plan to be adopted by MDH in collaboration with LHDs and MSDE must:
 include measures to enhance State and local public health efforts to monitor,
prevent, and mitigate the spread of COVID-19;
 assess the COVID-19 testing infrastructure;
 identify and address unmet testing needs;
 establish specific monthly testing goals;
 estimate funding required to implement surveillance testing goals and the extent to
which federal funding already received by the State can be used to achieve goals;
 require MDH to assist local jurisdictions that adopt strategies regarding accelerated
access to and use of at-home and point-of-care testing and incentivize and
encourage pharmacies and health care providers to offer testing;
 assess the contact tracing infrastructure and determine the optimal number of
contact tracing and related personnel;
 identify and address unmet contact tracing and related outbreak prevention and
mitigation efforts;
 establish goals for identifying, locating, and testing individuals who have been in
close contact with individuals who test positive for COVID-19;
 include a mechanism for monitoring performance of contact tracing and testing of
contacts;
 allow each local jurisdiction to establish and implement its own contact tracing
program; and
 have a design that addresses the disproportionate impact of the COVID-19
pandemic on underserved and minority communities in the State.
Grants to Local Jurisdictions
In both fiscal 2021 and 2022, MDH must provide local jurisdictions with (1) at least
$25.0 million in grants to expand capacity for COVID-19 testing, contact tracing, or any
other public health purpose related to COVID-19 response for which federal funding is
HB 836/ Page 2
authorized and (2) at least $15.0 million to vaccinate residents. Additional grant funding
must be provided to local jurisdictions that elect to establish independent contact tracing
programs. MDH may use only specified federal funding to provide grants. Grant funding
must be divided between local jurisdictions in proportion to their respective populations.
MDH must provide additional grant funding to a local jurisdiction if the department
determines that the initial allocation is not sufficient to meet the testing and contact tracing
or vaccination needs of the local jurisdiction.
A local jurisdiction may use grant funding for testing and contact tracing to expand
COVID-19 testing capacity through direct testing or by contracting with other entities. For
fiscal 2021 and 2022, MDH must provide additional funding to local jurisdictions that elect
to establish and implement an independent contact tracing program. The amount of funding
provided for an independent contact tracing program must be equivalent to the cost per
case amount provided under the State contact tracing contract.
Grants to Assisted Living Programs and Home Health Agencies
To the extent practicable, MDH must provide grant funding to assisted living programs
and home health agencies – up to $9.0 million in fiscal 2021 and $36.0 million in
fiscal 2022 – to cover the cost of COVID-19 testing for residents, patients, and staff. MDH
may use only specified federal funding to provide grants.
Additional Funding for Nursing Homes
The bill expresses legislative intent that the Governor include additional funding in the
budget – up to $5.5 million in fiscal 2021 and $22.0 million in fiscal 2022 – to cover the
cost of COVID-19 testing of nursing home staff and residents during calendar 2021.
Additional funding must (1) be in addition to any other provider rate increases included in
fiscal 2021 and 2022 budgets and (2) consist only of specified federal funding allocated to
the State.
Vaccination Plan
By June 1, 2021, MDH, with input from subject matter experts and other stakeholders,
must develop and submit to the General Assembly a comprehensive COVID-19
vaccination plan. The plan must include (1) specified information on the categories of
residents who will receive priority access to vaccines, the timeline for providing vaccines
to each priority category and the general public, and target metrics for vaccinating residents
in each priority category and the general public; (2) a dedication of time and resources to
target vaccine distribution and vaccine safety outreach efforts to communities
disproportionately impacted by COVID-19 infection, morbidity, and mortality; (3) a
vaccine distribution strategy that allocates resources and vaccines in an equitable manner
and accounts for the disproportionate impact of the COVID-19 pandemic on underserved
HB 836/ Page 3
and minority communities; and (4) a strategy for outreach and distribution of vaccines to
individuals who are not receiving the vaccine due to either lack of access or vaccine
hesitancy. After submission, MDH must provide weekly progress reports to the
General Assembly for the duration of calendar 2021.
Maryland Public Health Modernization Workgroup
The workgroup must assess the current public health infrastructure and resources in the
State and make recommendations for how to establish a modern and effective public health
system with a capacity to (1) monitor, prevent, control, and mitigate the spread of infectious
disease and (2) achieve State Health Improvement Process goals. The workgroup must also
make recommendations regarding the establishment of a Maryland Public Health Job
Corps to respond to COVID-19 or similar outbreaks and consider, where appropriate, the
use of federal funds to implement any recommendations made by the workgroup. By
December 1, 2021, MDH must submit a report to the General Assembly that includes the
workgroup’s findings and recommendations.
Assisted Living Programs and Nursing Home COVID-19 Testing Plans
For calendar 2021 and 2022, assisted living programs and nursing homes must adopt and
implement COVID-19 testing plans for residents and staff. The plans must ensure that
residents and staff are regularly tested for COVID-19, as specified. MDH must adopt
regulations that set standards for the testing plans; standards must be guided by applicable
federal orders and policies and include requirements for testing frequency that are
reasonably related to the COVID-19 testing positivity rate in the local jurisdiction in which
the assisted living program or nursing home is located.
Home Health Agency Infection Control and Prevention Plans
For calendar 2021 and 2022, home health agencies must adopt and implement a COVID-19
infection control and prevention plan for patients and staff. The plan must (1) be adopted
and implemented in accordance with any applicable federal orders and guidance and
(2) ensure that patients and staff are regularly screened for COVID-19 and tested or
referred for testing for COVID-19 if required or recommended, as specified. Screening
must include reporting to the home health agency of any symptoms related to or known
exposure to COVID-19 by patients and staff. Home health agencies must provide the plan
to patients and staff, and members of the public on request.
Higher Education COVID-19 Security Plans
For calendar 2021, an institution of higher education that has residence halls for students
must establish a COVID-19 security plan that includes screening and testing procedures
that will keep students, faculty, and staff safe while on campus for face-to-face instruction
HB 836/ Page 4
during the pandemic. The plan must be posted on the website of the institution of higher
education and made available to the public.
Mandated Health Insurance Coverage of COVID-19 Tests
“COVID-19 test” includes a federal Food and Drug Administration (FDA) approved,
cleared, or authorized rapid point-of-care test and an at-home collection test.
Each individual and small employer health benefit plan issued or delivered in the State by
an insurer, nonprofit health service plan, or health maintenance organization must provide
coverage for COVID-19 tests and related items and services for the administration of such
tests, including facility fees, health care practitioner fees, and evaluation of the member for
purposes of determining the need for the test, as required by the federal Families First
Coronavirus Response Act, the federal CARES Act, and any applicable federal regulations
or guidance. Coverage must be provided without a copayment, coinsurance requirement,
or deductible for COVID-19 tests and related items and services for their administration.
Federal Funding for Implementation
Any funding appropriated for implementation of the bill may consist only of federal
funding allocated to the State under the federal Coronavirus Response and Relief
Supplemental Appropriations Act and any other federal legislation enacted in
calendar 2020 through 2022. Any federal funding appropriated under the bill for vaccine
distribution, testing, or contact tracing must be limited to funding specifically allocated for
those purposes under the CARES Act, the Consolidated Appropriation Act, or the
American Rescue Plan Act of 2021, except to the extent other funding is provided for these
purposes by the Governor.
Miscellaneous
The bill delays, from July 1, 2021, to January 1, 2022, the effective date of Chapter 365 of
2020, which (along with Chapter 366 of 2020) establishes specified requirements relating
to hospitals that charge an outpatient facility fee.
Current Law:
Maryland Response to COVID-19
Chapters 13 and 14 of 2020 authorized the Governor to take actions to facilitate access to
health care and the provision of that care and to mitigate costs to individuals for COVID-19
diagnosis and treatment. Specifically, the Governor may (1) prohibit cost-sharing by a
carrier for COVID-19 testing (and associated costs) conducted based on testing protocols
recommended by the Secretary of Health; (2) order MDH to cover the cost of COVID-19
HB 836/ Page 5
testing (and associated costs) if the costs would not otherwise be paid for by a carrier or
another third party; and (3) require carriers and Medicaid to cover a COVID-19
immunization (and any associated costs), without cost-sharing, if the patient belongs to a
category of individuals to whom MDH has determined cost-sharing should not apply.
In response to COVID-19, MIA adopted several sets of emergency regulations and
bulletins, including requiring carriers to (1) waive any cost-sharing for any visit to diagnose
or test for COVID-19, regardless of the setting of the testing; (2) waive any cost-sharing
for laboratory fees to diagnose or test for COVID-19; (3) waive any cost-sharing for
vaccination for COVID-19; (4) evaluate a request to use an out-of-network provider to
perform diagnostic testing of COVID-19; and (5) consider an adverse decision on a request
for coverage of diagnostic services for COVID-19 an emergency case for which an
expedited grievance procedure is required.
Federal Requirements Regarding Insurance Coverage of COVID-19 Testing
Under the federal Families First Coronavirus Response Act, all public and private health
insurance (including self-funded plans) must cover FDA-approved COVID-19 tests and
associated costs without cost-sharing. However, coverage is only required if the test is
deemed medically appropriate by an attending health care provider. There is no limit on
the number of COVID-19 tests that must be covered for an individual, as long as each test
is deemed medically appropriate and the individual has signs or symptoms of or known or
suspected recent exposure to COVID-19. Coverage is not required for routine tests to
screen for general workplace health and safety, public health surveillance, or any other
purpose not intended for individualized diagnosis and treatment of COVID-19 or another
condition.
Federal Funding for COVID-19
To date, $4.1 billion in federal funds has been allocated to MDH for the State’s COVID-19
response, including $737.1 million for testing and contact tracing and $281.5 million for
vaccine distribution. Approximately $3.3 billion of these funds is reflected in the operating
budgets from fiscal 2020 through 2022 after accounting for appropriations added in the
second and fifth supplemental budgets. The federal American Rescue Plan Act of 2021
provides additional federal aid for testing, contact tracing, and vaccine distribution, among
other programs and activities. State awards from some of these funding sources allocated
through the American Rescue Plan Act have not been announced, but are likely to
substantially increase the available federal funding to the State for COVID-19 response.
An additional $5.9 billion in federal funds has been allocated to counties, LHDs, and health
care providers (including $6.0 million for nursing home testing costs).
For additional information about COVID-19, please see the Appendix – COVID-19.
HB 836/ Page 6
State Expenditures: Any funding appropriated for the implementation of the bill may
consist only of federal funding allocated to the State under the federal Coronavirus
Response and Relief Supplemental Appropriations Act and any other federal legislation
enacted in calendar 2020 through 2022. As noted above, to date, $4.1 billion in
federal funds has been allocated to MDH for the State’s COVID-19 response, and
significant additional funding is anticipated to be received under the federal American
Rescue Plan Act of 2021. Accordingly, sufficient federal funding is available for the
purposes required under the bill. The funding required would likely have been provided to
and through MDH absent the bill; however, the specific purposes, timing, and distribution
may have been different.
Grants to Local Jurisdictions and Health Care Facilities
MDH federal fund expenditures of at least $54.5 million in fiscal 2021 and at least
$98.0 million in fiscal 2022 are required to provide grants to local jurisdictions and health
care facilities as shown in Exhibit 1.
Exhibit 1
Mandated Grant Funding to Local Jurisdictions and Health Care Facilities
($ in Millions)
FY 2021 FY 2022
Locals – Testing/Contact Tracing* $25.0 $25.0
Locals – Vaccinations* 15.0 15.0
Assisted Living/Home Health Agencies – Testing** 9.0 36.0
Nursing Homes – Testing 5.5 22.0
Total $54.5 $98.0
*The bill requires at least $25.0 million in grants for testing and contact tracing and at least $15.0 million
in grants to vaccinate residents; additional funding must be provided if the initial allocation is not sufficient
to meet local needs. Additional funding must also be provided to local jurisdictions that elect to establish
independent contact tracing programs.
**The bill requires up to $9.0 million for this purpose in fiscal 2021 (and $36.0 million in fiscal 2022); this
analysis assumes the full amount is expended and that the ceiling applies only to fiscal 2021 spending.
Source: Department of Legislative Services
HB 836/ Page 7
COVID-19 Response Plan and Vaccination Plan
MDH can likely devel