HB 1022
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
House Bill 1022 (Delegate Pendergrass)
Health and Government Operations Finance
Public Health - State Designated Exchange - Clinical Information
This bill requires a nursing home, on request of the Maryland Department of Health
(MDH), to electronically submit clinical information to the State-designated exchange. The
exchange may provide the information to specified entities. If approved by the Maryland
Health Care Commission (MHCC), the information may be combined with other data
maintained by the exchange to facilitate (1) a State health improvement program;
(2) mitigation of a public health emergency; and (3) improvement of patient safety. The
information may not be used for any other purpose, including licensing and certification.
The bill requires an “electronic health network” (EHN) to provide specified “electronic
health care transactions” and prohibits an EHN from charging a fee for such transactions.
Uncodified language requires MDH to identify and seek appropriate funding to implement
the bill. By January 1, 2022, MHCC must report to the Governor and the General Assembly
on the availability of funding and the sustainability of the technical infrastructure required
to implement the bill. The bill takes effect July 1, 2021.
Fiscal Summary
State Effect: MDH can identify and seek appropriate funding within existing budgeted
resources. Expenditures (likely general and/or federal funds) increase beginning as early
as FY 2022 to implement the bill’s requirements. To the extent nursing home costs increase
under the bill, Medicaid expenditures (50% general funds, 50% federal funds) and federal
matching revenues may increase, as discussed below.
Local Effect: None.
Small Business Effect: Potential meaningful.
 Analysis
Bill Summary: “Electronic heath care transactions” means health care transactions that
have been approved by a nationally recognized health care standards development
organization to support health care informatics, information exchange, systems integration,
and other health care applications.
“Electronic health network” means an entity (1) involved in the exchange of electronic
health care transactions between a payor, health care provider, vendor, and any other entity;
and (2) certified by MHCC.
In accordance with State and federal law, the exchange may provide the clinical
information submitted by a nursing home to (1) a health care provider; (2) an authorized
health information exchange user; (3) a health information exchange (HIE) authorized by
MHCC; (4) a federal official; (5) and a State official.
An EHN must provide electronic health care transactions to the exchange for the following
public health and clinical purposes: (1) a State health improvement program; (2) mitigation
of a public health emergency; and (3) improvement of patient safety. An EHN may not
charge a fee to a health care provider, health care payor, or to the State-designated exchange
for providing the required information.
The exchange must develop and implement policies and procedures that are consistent with
regulations adopted by MHCC. The adopted regulations must provide for a uniform,
gradual implementation of the exchange of clinical information. Regulations must (1) limit
redisclosure of financial information, including billed or paid amounts available in
electronic claims transactions; (2) restrict data of patients who have opted out of records
sharing through the exchange or an HIE authorized by MHCC; and (3) restrict data from
health care providers that possess sensitive health care information.
Current Law: In general, a nursing home is a facility that offers nonacute inpatient care
to patients suffering from a disease, chronic illness, condition, disability of advanced age,
or terminal disease requiring maximal nursing care without continuous hospital services
and who require medical services and nursing services rendered by or under the supervision
of a licensed nurse together with convalescent, restorative, or rehabilitative services.
MHCC designated the Chesapeake Regional Information System for our Patients (CRISP)
as the statewide HIE in 2009, and the infrastructure became operational in 2010. An HIE
allows clinical information to move electronically among disparate health information
systems. CRISP offers tools aimed at improving the facilitation of care for the region’s
health care providers. Consumers can opt out of having their information included in an
HIE.
HB 1022/ Page 2
State Fiscal Effect: MDH is required to identify and seek appropriate funding to
implement the bill’s requirements and report to the Governor and the General Assembly.
This can be handled with existing budgeted resources.
Depending on the details of the regulations adopted by MHCC and the funding source(s)
identified by MDH, MDH expenditures (likely general and/or federal funds) increase
beginning as early as fiscal 2022 to implement the bill, including linking nursing homes
with CRISP. Federal emergency funds provided to the State and to nursing homes for the
COVID-19 public health emergency may be available for this purpose.
To the extent that expenditures increase significantly for nursing homes under the bill,
Medicaid provider rates may increase by an indeterminate amount (50% general funds,
50% federal funds) beginning as early as fiscal 2022 to reimburse for increased costs.
Federal fund revenues increase accordingly.
Small Business Effect: Under the bill, small business nursing homes, on the request of
MDH, must electronically submit clinical information to the State-designated exchange. In
general, nursing homes do not currently use CRISP, and they must establish a process to
electronically submit such information. MDH advises that it is unclear if small business
nursing homes have the ability to connect to CRISP or what the cost to each facility may
be. To the extent these costs are incurred by nursing homes (and not by another potential
source of funding to be identified under the bill), expenditures for small business nursing
homes increase.
Additional Comments: According to CRISP, nursing home connectivity to the HIE has
been hindered due to multiple factors, including electronic health record capabilities,
resource concerns, and competing priorities. Connection to the HIE could provide public
health support for nursing homes for real-time monitoring, public health reporting, safer
transitions of care, enhanced hospital coordination, and targeted interventions for
high-needs residents.
Additional Information
Prior Introductions: None.
Designated Cross File: SB 748 (Senator Beidle) - Finance.
Information Source(s): Maryland Department of Health; Department of Legislative
Services
HB 1022/ Page 3
Fiscal Note History: First Reader - March 1, 2021
rh/jc Third Reader - March 24, 2021
Revised - Amendment(s) - March 24, 2021
Analysis by: Amberly Holcomb Direct Inquiries to:
(410) 946-5510
(301) 970-5510
HB 1022/ Page 4


Statutes affected:
Text - First - Public Health - State Designated Exchange - Clinical Information: 4-302.3 Health General
Text - Third - Public Health - State Designated Exchange - Clinical Information: 4-302.3 []