SB 837
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
Senate Bill 837 (Senator Kramer)
Finance Health and Government Operations
Health - Advance Care Planning and Advance Directives
This bill requires the Maryland Health Care Commission (MHCC) in the Maryland
Department of Health (MDH) to coordinate implementation of advance care planning
programs in the State. Each carrier must offer electronic advance directives to its members
or enrollees as specified. The Motor Vehicle Administration (MVA) must submit a report
by December 1, 2021, that provides an update on the status of implementing specified
requirements related to advance directives. The bill takes effect June 1, 2021; the
insurance provisions apply to all policies, contracts, and health benefit plans issued,
delivered, or renewed in the State on or after that date.
Fiscal Summary
State Effect: The affected agencies (MDH, MVA, and the Maryland Insurance
Administration) advise that the bill’s requirements can be implemented with existing
budgeted resources. Revenues are not affected.
Local Effect: None.
Small Business Effect: None.
Analysis
Bill Summary:
Maryland Department of Health
The coordination provided by MHCC must include (1) the adoption and implementation
of measures requiring that “health systems” and health care providers encourage
individuals to upload, create, update, and make accessible electronic advance care planning
documents through the use of an electronic advance directive service recognized by MHCC
and connection to the State-designated health information exchange and (2) development
and implementation of quality metrics for the adoption and use of processes and tools by
health care systems and health care providers to facilitate advance care planning by
individuals.
“Health system” means a parent corporation of one or more hospitals or a hospital and any
entity affiliated with the parent corporation or hospital through ownership, governance
membership, or other means.
Carrier Requirements
Each carrier must offer electronic advance directives to its members or enrollees during
open enrollment and periodically thereafter and make arrangements to receive status
notifications as to whether members or enrollees have completed or updated an advance
directive. In doing so, a carrier may contract with an electronic advance directives service
if the service (1) is approved by MHCC and (2) meets the technology, security, and privacy
standards set by MHCC.
Motor Vehicle Administration
The MVA report must include (1) a timeline for implementation of the requirements of
§ 12-303.1 of the Transportation Article; (2) identification of any obstacles to
implementation; and (3) measures being taken by MVA to resolve any identified obstacles
and implement the requirements.
Current Law:
Maryland Department of Health
In general, an advance directive allows an adult who has decision making capacity to deal
with future health care issues through written instructions, a written appointment of an
agent, or an oral statement to a physician or nurse practitioner. The advance directive
outlines the individual’s instructions regarding the provision of health care or withholding
or withdrawing health care. The individual may name an agent to make health care
decisions under circumstances stated in the directive, and the authority of surrogate
decision makers is specified based on their relationships with the individual. The directive
becomes effective when two physicians have certified in writing that the patient is
incapable of making an informed decision.
With the exception of an electronic advance directive that has been authenticated in a
specified manner, a written or electronic advance directive generally must be dated, signed
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by or at the express direction of the individual making the advance directive, and
subscribed by two witnesses.
MDH is required to develop an information sheet, in consultation with the Office of the
Attorney General, which provides information relating to advance directives.
MHCC recognizes electronic advance directive services to be authorized for connection to
the State-designated health information exchange subject to security provisions. An
individual may register an advance directive with such a service recognized by MHCC.
Carrier Requirements
A carrier must provide the advance directive information sheet developed by MDH (1) in
the carrier’s member publications; (2) on the carrier’s website; and (3) at the request of a
member.
Motor Vehicle Administration
Pursuant to § 12-303.1 of the Transportation Article, MVA must provide a method that
allows an applicant for a driver’s license or identification card to (1) be made aware of, and
informed how to obtain, the advance directive information sheet developed by MDH and
(2) indicate that the individual has an advance directive registered with MDH.
Additional Information
Prior Introductions: None.
Designated Cross File: None.
Information Source(s): Maryland Department of Health; Maryland Department of
Transportation; Maryland Insurance Administration; Department of Legislative Services
Fiscal Note History: First Reader - March 9, 2021
rh/jc Third Reader - March 31, 2021
Revised - Amendment(s) - March 31, 2021
Analysis by: Amber R. Gundlach Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 837/ Page 3


Statutes affected:
Text - First - Health - Advance Care Planning and Advance Directives: 19-145 Insurance, 15-122.1 Insurance
Text - Third - Health - Advance Care Planning and Advance Directives: 19-145 Health General, 15-122.1 Insurance