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Bills (80 found)
Requiring a carrier that issues Medicare supplement policies to issue a Medicare supplement policy to an individual who meets certain criteria during certain special enrollment periods.
Altering the grounds on which the Maryland Insurance Commissioner may deny an applicant for registration as or refuse to renew, suspend, or revoke the registration of a third party administrator; and altering the violations for which the Commissioner may impose civil penalties against a third party administrator.
Altering the grounds on which the Maryland Insurance Commissioner may deny an applicant for registration as or refuse to renew, suspend, or revoke the registration of a third party administrator; and altering the violations for which the Commissioner may impose civil penalties against a third party administrator.
Altering the effective dates of enrollment in a Small Business Health Options (SHOP) Exchange plan for individuals who enroll during certain special enrollment periods; etc.
Codifying in State law certain provisions of the Code of Federal Regulations related to mental health parity and clarifying the authority of the Maryland Insurance Administration to enforce certain laws; requiring health insurance carriers to collect and report on data in a certain manner; requiring health insurance carriers to provide certain benefits under certain circumstances; requiring health insurance carriers to explain differences in access to care under certain circumstances; etc.
Shortening, from 120 to 90, the maximum interval of days that certain carriers may impose as a frequency limitation on dental preventive care; and applying the Act to all policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or after January 1, 2027.
Altering the effective dates of enrollment in a Small Business Health Options (SHOP) Exchange plan for individuals who enroll during certain special enrollment periods.
Requiring a carrier that issues Medicare supplement policies to issue a Medicare supplement policy to an individual who meets certain criteria during certain special enrollment periods.
Authorizing certain insurers, nonprofit health service plans, and health maintenance organizations to join bulk purchasing pools for prescription drugs.
Codifying in State law certain provisions of the Code of Federal Regulations related to mental health parity and clarifying the authority of the Maryland Insurance Administration to enforce certain laws; requiring health insurance carriers to collect and report on data in a certain manner; requiring health insurance carriers to provide certain benefits under certain circumstances; requiring health insurance carriers to explain differences in access to care under certain circumstances; etc.
Requiring certain insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations that provide coverage for chemotherapy to treat cancer to provide coverage for scalp cooling systems used for the preservation of hair in connection with chemotherapy treatment; and applying the Act to all policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or after January 1, 2027.
Prohibiting insurers, nonprofit health service plans, and health maintenance organizations from imposing a copayment, coinsurance, or deductible for covered physical therapy services that is greater than the copayment, coinsurance, or deductible imposed for an annual physical or wellness visit under the same plan or contract.
Requiring the Maryland Medical Assistance Program and certain insurers, nonprofit health service plans, and health maintenance organizations to provide certain coverage related to orthoses beginning January 1, 2027; clarifying that certain mandated benefits related to prostheses include all prostheses determined by a treating health care provider to be medically necessary for completing daily living activities, essential job-related activities, or performing certain other physical activities; etc.
Requiring certain insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations that provide coverage for chemotherapy to treat cancer to provide coverage for scalp cooling systems used for the preservation of hair in connection with chemotherapy treatment; and applying the Act to all policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or after January 1, 2027.
Requiring the Maryland Medical Assistance Program and certain insurers, nonprofit health service plans, and health maintenance organizations to provide certain coverage related to orthoses beginning January 1, 2027; clarifying that certain mandated benefits related to prostheses include all prostheses determined by a treating health care provider to be medically necessary for completing daily living activities, essential job-related activities or performing certain other physical activities; etc.
Requiring certain entities to provide reimbursement to health care providers in a manner that meets the annual primary care investment targets established by the State on or after February 1, 2026; and requiring certain entities to provide a description of the entity's progress in meeting the annual primary care investment targets to the Maryland Insurance Commissioner when filing a premium rate or premium rate change with the Commissioner.
Requiring the Secretary of Health to issue recommendations for certain immunizations, screenings, and preventive services based on certain evidence-based scientific and clinical guidance; altering the authority of pharmacists to administer certain vaccinations; altering the health insurance coverage requirements for certain immunizations, screenings, and preventive services; and repealing obsolete language regarding the pertussis vaccine.
Requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide individuals with salpingectomy coverage for ovarian cancer prevention; and prohibiting the insurers, nonprofit health service plans, and health maintenance organizations from imposing a copayment, coinsurance, or deductible requirement on the salpingectomy coverage.
Requiring the Secretary of Health to issue recommendations for certain immunizations, screenings, and preventive services based on certain evidence-based scientific and clinical guidance; altering the authority of pharmacists to administer certain vaccinations; altering the health insurance coverage requirements for certain immunizations, screenings, and preventive services; and repealing obsolete language regarding the pertussis vaccine.
Prohibiting the Maryland Department of Health and certain carriers from imposing a copay, coinsurance, or deductible for services provided in accordance with the Collaborative Care Model statewide in primary care settings that provide health care services to Program recipients.
Requiring certain health systems to comply with certain insurance provisions regarding notice of termination of contracts; altering the notification requirements a carrier is required to provide an enrollee regarding changes to the carrier's provider panel; altering the notice requirements a carrier is required to provide to the Insurance Commissioner for certain material changes to the carrier's provider panel; requiring certain notice if a carrier and health system intend to terminate certain contracts; etc.
Requiring insurers, nonprofit health service plans, and health maintenance organizations to send certain communications in a certain manner; establishing that certain communications by insurers, nonprofit health service plans, and health maintenance organizations shall be considered denials of all or part of certain claims for reimbursement; and requiring insurers, nonprofit health service plans, and health maintenance organizations to deny all or part of certain claims for reimbursement under certain circumstances.
Prohibiting the Maryland Department of Health and certain carriers from imposing a copay, coinsurance, or deductible for services provided in accordance with the Collaborative Care Model statewide in primary care settings that provide health care services to Program recipients.
Requiring that a carrier's internal grievance process provide for human review of grievances resulting from adverse decisions made using artificial intelligence, algorithm, or other software tools; requiring carriers to report certain information on grievances resulting from adverse decisions made using artificial intelligence, algorithm, or other software tools; requiring a carrier to provide a model review process under certain circumstances; etc.
Requiring insurers, nonprofit health service plans, and health maintenance organizations that owe interest on claims under a certain provision of law to provide certain remittance advice that separately identifies and itemizes the interest owed claims.
Requiring the Maryland Medical Assistance Program and certain insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations to provide coverage for services provided in any setting by certain certified peer recovery specialists; and requiring the Maryland Department of Health to convene a certain workgroup on the certification process of peer recovery specialists.
Requiring certain health systems to comply with certain insurance provisions regarding notice of termination of contracts; altering the notification requirements a carrier is required to provide an enrollee regarding changes to the carrier's provider panel; altering the notice requirements a carrier is required to provide to the Insurance Commissioner for certain material changes to the carrier's provider panel; requiring certain notice if a carrier and health system intend to terminate certain contracts; etc.
Requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide individuals with salpingectomy coverage for ovarian cancer prevention; and prohibiting the insurers, nonprofit health service plans, and health maintenance organizations from imposing a copayment, coinsurance, or deductible requirement on the salpingectomy coverage.
Altering the circumstances under which a carrier may retroactively deny reimbursement; altering the information a carrier is required to provide to a health care provider if the carrier retroactively denies reimbursement; prohibiting a carrier from retroactively denying reimbursement under certain circumstances; and requiring certain carriers that retroactively deny reimbursement to develop a certain training plan for health care providers.
Requiring the Maryland Medical Assistance Program and certain health insurers, nonprofit health services plans, and health maintenance organizations to provide coverage for single-gene and multigene pharmacogenomic testing in certain circumstances; and limiting the prior authorization requirements that certain health insurers, nonprofit health services plans, and health maintenance organizations may implement for pharmacogenomic testing.
Prohibiting insurers, nonprofit health service plans, and health maintenance organizations from imposing a copayment, coinsurance, or deductible for covered physical therapy services that is greater than the copayment, coinsurance, or deductible imposed for an annual physical or wellness visit under the same plan or contract.
Establishing the Meds-to-Beds Program in the Maryland Department of Health: providing the purpose of the Program is to reduce hospital readmissions by using a licensed pharmacist to deliver discharge medications to patients before they leave the hospital; requiring each hospital in the State to participate in the Program; authorizing certain health care facilities to use automated drug dispensing systems and remote dispensing systems; and altering the definition of "telehealth" as it applies to certain insurance coverage.
Requiring certain health insurance carriers to provide certain special enrollment periods, of 60 days beginning on the first day of employment, for individuals who become employed by small employers that do not offer employer-sponsored health plans.
Requiring the Maryland Medical Assistance Program and certain insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations to provide coverage for mobile crisis and crisis stabilization services; and applying the Act to all policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or after January 1, 2027.
Exempting from certain requirements relating to the offering of health benefit plans to small employers in the State health benefit plans issued through a professional employer organization located in the State; and requiring professional employer organizations that enter into agreements with small employers to provide health benefit plans to disclose certain information in writing.
Requiring each carrier that provides a health benefit plan in the State to report certain data regarding claims and coverage to the Maryland Insurance Commissioner using a certain template; requiring the Commissioner to develop a template for carriers to report the data and make the data publicly available by posting certain data on a public website and developing and maintaining certain data dashboards; etc.
Prohibiting insurers, nonprofit health service plans, health maintenance organizations, and managed care organization from downcoding a claim for reimbursement under certain circumstances; establishing certain procedures that insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations are required to follow if the insurer, nonprofit health service plan, or health maintenance organization intends or makes a final decision to downcode a claim; etc.
Establishing requirements for certain vision benefits, vision benefit plans, and vision benefit discount plans; requiring an insurer or a vision benefit manager to disclose certain information on its website and in certain communications and maintain certain methods of communication for use by participating eye care providers; establishing certain requirements and prohibitions for contracts between insurers or vision benefit managers and participating eye care providers; etc.
Authorizing an individual who enrolls for coverage or enrolls a dependent for coverage during a certain special enrollment period for pregnancy to choose a certain date option on which the coverage will become effective; and requiring the carrier, if the individual fails to select the effective date, to select a certain date option.
Requiring that the annual report on the Abortion Care Clinical Training Program include certain recommendations; and requiring the Maryland Insurance Commissioner to collect certain data on certain segregated accounts established under the federal Affordable Care Act and certain federal regulations from certain insurers, nonprofit health service plans, and health maintenance organizations and submit a certain report to the Senate Finance Committee and the House Health Committee on or before January 1 each year.
Prohibiting certain insurers and dental plan organizations from prohibiting an assignment of benefits to a provider who is a dentist by an insured or refusing to directly reimburse a nonpreferred provider who is a dentist; requiring a nonpreferred provider who is a dentist and who seeks an assignment of benefits from an insured or enrollee to provide certain information to the insured or enrollee before performing a health care service and submit a disclosure form to document the assignment of benefits; etc.
Altering the process by which health care providers apply to participate on a carrier's provider panel, including certain notice requirements; establishing certain civil penalties for carriers that fail to provide certain notices in a certain manner and during a certain time frame; repealing the authorization for a carrier to charge a certain application fee; requiring carriers to use certain information to update the carrier's provider directory at a certain frequency; etc.
Prohibiting a managed care organization and certain insurers, nonprofit health service plans, and health maintenance organizations from requiring a prior authorization or step therapy or fail-first protocol under certain circumstances for prescription drugs that have been reviewed by the Prescription Drug Affordability Board; etc.
Altering the membership of the State Advisory Council on Health and Wellness; requiring certain health occupations boards that require a licensee or certificate holder to complete continuing education requirements as a condition of renewal to grant at least a certain amount of continuing education credits for completing continuing education on perimenopausal, menopausal, and postmenopausal evaluation and treatment; etc.
Requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for screening for perinatal mental health conditions at certain times; requiring the Maryland Department of Health to establish a perinatal mental health condition screening program; requiring certain applicants for the renewal of a health occupation license or certificate to provide documentation that the applicant completed continuing education credit hours on perinatal mental health conditions; etc.
Establishing that insureds and any other persons covered by certain health insurance policies, contracts, or certificates are entitled to reimbursement for the services rendered by a graduate-level counseling, social work, or psychology clinical intern under certain circumstances.
Establishing that insureds and any other persons covered by certain health insurance policies, contracts, or certificates are entitled to reimbursement for the services rendered by a graduate-level counseling, social work, or psychology clinical intern under certain circumstances; providing the services are reimbursable if provided at an outpatient health care facility by a social work intern who is enrolled in a graduate program and is under the direct supervision of a licensed certified social worker-clinical; etc.
Altering the process by which health care providers apply to participate on a carrier's provider panel, including certain notice requirements; establishing certain civil penalties for carriers that fail to provide certain notices in a certain manner and during a certain time frame; repealing the authorization for a carrier to charge a certain application fee; requiring carriers to use certain information to update the carriers' provider directory at a certain frequency; etc.
Prohibiting certain insurers and dental plan organizations from prohibiting an assignment of benefits to a provider who is a dentist by an insured or refusing to directly reimburse a nonpreferred provider who is a dentist; requiring a nonpreferred provider who is a dentist and who seeks an assignment of benefits from an insured or enrollee to provide certain information to the insured or enrollee before performing a health care service and submit a disclosure form to document the assignment of benefits; etc.
Requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for screening for perinatal mental health conditions at certain times; requiring the Maryland Department of Health to establish a perinatal mental health condition screening program; requiring certain applicants for the renewal of a health occupation license or certificate to provide documentation that the applicant completed continuing education credit hours on perinatal mental health conditions; etc.
Requiring the Maryland Medical Assistance Program, subject to certain limitations, to provide coverage for approved elopement response devices and supports; requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for approved elopement response devices and associated supports to certain individuals under certain circumstances; etc.
Altering the duties of the Health Insurance Coverage Protection Commission to require the Commission to study and make recommendations regarding individual and group health insurance market stability.
Requiring the Maryland Medical Assistance Program and certain insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations to provide coverage to victims of domestic violence for aesthetic services and restorative care related to scars or scarring determined to be medically necessary for the treatment of physical injuries caused by domestic violence.
Prohibiting certain carriers and managed care organizations from prohibiting an enrollee from selecting, or limiting the ability of an enrollee to select, a laboratory; prohibiting certain carriers and managed care organizations from denying a laboratory the right to participate in the health benefit plan if the laboratory agrees to comply with certain terms; and prohibiting certain carriers and managed care organizations from imposing additional copayments, fees, or conditions for laboratory services provided to an enrollee.
Altering the membership of the State Advisory Council on Health and Wellness; requiring certain health occupations boards that require a licensee or certificate holder to complete continuing education requirements as a condition of renewal to grant at least a certain amount of continuing education credits for completing continuing education on perimenopausal, menopausal, and postmenopausal evaluation and treatment; etc.
Requiring that the annual report on the Abortion Care Clinical Training Program include certain recommendations; and requiring the Maryland Insurance Commissioner to collect certain data on certain segregated accounts established under the federal Affordable Care Act and certain federal regulations from certain insurers, nonprofit health service plans, and health maintenance organizations and submit a certain report to the Senate Finance Committee and the House Health Committee on or before January 1 each year.
Requiring each carrier that provides a health benefit plan in the State to report certain data regarding claims and coverage to the Maryland Insurance Commissioner using a certain template; requiring the Commissioner to develop a template for carriers to report the data and make the data publicly available by posting certain data on a public website and developing and maintaining certain data dashboards; etc.
Prohibiting insurers, nonprofit health service plans, health maintenance organizations, and managed care organization from downcoding a claim for reimbursement under certain circumstances; establishing certain procedures that insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations are required to follow if the insurer, nonprofit health service plan, or health maintenance organization intends or makes a final decision to downcode a claim; etc.
Requiring the Maryland Department of Health to replace the State Medicaid Management Information System mainframe with a modular system.
Requiring that, on or after October 1, 2027, certain facilities provide patients with certain access to palliative care and inform patients about the availability of palliative care at certain times; requiring the Department of Health to adopt regulations establishing minimum standards for palliative care, including staffing, training and quality assurance requirements; requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide health insurance coverage for certain palliative care; etc.
Requiring insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for a certain supply of prescription drugs used for gender-affirming care, hormone therapy, or reproductive health in certain circumstances; and altering the amount of certain prescription drugs that a pharmacist is allowed to dispense on or after January 1, 2027.
Requiring the Maryland Medical Assistance Program, the Maryland Children's Health Program, managed care organizations, and certain health insurers, nonprofit health service plans, and health maintenance organizations to provide a prior authorization determination regarding a transfer on request of a special pediatric hospital or a referring health care provider and provide a retrospective review of a determination of medical necessity under certain circumstances; etc.
Requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide certain coverage for the full length of long-term antibiotic treatment of Lyme disease and related tick-borne illnesses under certain circumstances; and prohibiting certain insurers, nonprofit health service plans, and health maintenance organizations from placing a quantitative limit on or denying coverage for benefits required under the Act.
Establishing a Commission on Re-Imagining Health Care to envision and make recommendations regarding establishing a comprehensive health care system in the State; and requiring the Commission to submit a preliminary report by December 1, 2027, and a final report of the Commission's findings and recommendations to the Governor and the General Assembly by December 1, 2029.
Requiring health occupations boards that require licensees or certificate holders to complete certain continuing education to grant a certain number of hours for every hour of continuing education for menopause and menopause-associated symptoms; requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for the evaluation and management of menopause and menopause-associated conditions; etc.
Requiring that certain audits and compliance reviews of an artificial intelligence, algorithm, or other software tool used for utilization review include a certain evaluation by a licensed health care professional; and requiring that the review and revision of the performance, use, and outcomes of an artificial intelligence, algorithm, or other software tool used for utilization review include a certain human evaluation and use of the findings of the evaluation for a certain purpose.
Requiring, on or before July 1, 2028, the Maryland Department of Health to select and contract with a State pharmacy benefits manager; requiring that each managed care contract entered into or renewed after July 1, 2028, require the managed care organization to contract with and use the State pharmacy benefits manager; and requiring the Department to engage an independent consultant to advise it in selecting and contracting with the State pharmacy benefits manager.
Prohibiting a managed care organization and certain insurers, nonprofit health service plans, and health maintenance organizations from requiring a prior authorization or step therapy or fail-first protocol under certain circumstances for prescription drugs that have been reviewed by the Prescription Drug Affordability Board; etc.
Requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide certain coverage for hormone-related care, including hormone therapy treatment for perimenopausal and menopausal symptoms; establishing certain requirements and prohibitions related to coverage for hormone-related care; requiring certain insurers, nonprofit health service plans, and health maintenance organizations to report to the Maryland Insurance Administration certain data related to hormone-related care; etc.
Requiring, under certain circumstances, an insurer, a nonprofit health service plan, a health maintenance organization, a dental plan organization, a managed care organization, or any other entity providing health benefit plans in the State to identify primary and secondary payors, the amounts payable by those payors, and to coordinate benefits with those identified payors; and altering the time period in which a carrier may retroactively deny reimbursement subject to coordination of benefits with another carrier.
Exempting from certain requirements relating to the offering of health benefit plans to small employers in the State health benefit plans issued through a professional employer organization located in the State; and requiring professional employer organizations that enter into agreements with small employers to provide health benefit plans to disclose certain information in writing.
Requiring the Maryland Insurance Administration to convene a workgroup to study a certain definition of specialty drug in a certain manner and make a recommendation to the Governor and the General Assembly by January 1, 2027, for a new definition of specialty drug.
Requiring third-party administrators of plans that provide health benefits to develop a process through which a health care provider can request information to determine the eligibility of an enrollee and the administrator can respond to a request in a timely manner; and prohibiting certain carriers from retroactively denying reimbursement to a provider who used a certain process to confirm an enrollee was eligible for certain services.
Altering the circumstances under which certain insurers, nonprofit health service plans, and health maintenance organizations are prohibited from excluding coverage for certain specialty drugs for the treatment of rheumatologic conditions.
Establishing the Maryland Helping Everyone Afford Life-Saving Treatments and Health Care (HEALTH) Fund as a special, nonlapsing fund to assist Maryland Medical Assistance Program enrollees, insured individuals, and uninsured individuals with health care costs associated with legally protected health care services and benefits provided under State law that are subject to federal restrictions; requiring that certain sources of revenue be distributed or credited to the Fund; etc.
Requiring the Secretary of Budget and Management to include a certain obesity management and treatment program in the State Employee and Retiree Health and Welfare Benefits Program; establishing requirements for the obesity management and treatment program; and requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for an obesity management and treatment program for certain individuals who have been diagnosed with obesity, diabetes, or other obesity-related conditions.
Prohibiting certain policies and contracts issued by insurers, nonprofit health service plans, and health maintenance organizations from denying insurance coverage for certain emergency room services under certain circumstances; requiring the Maryland Health Care Commission, in conjunction with the Health Services Cost Review Commission, to conduct a study to quantify bed capacity in hospitals and post-acute settings in the State and make a recommendation on a certain collection and auditing process; etc.
Requiring certain insurers, nonprofit health service plans, and health maintenance organizations to provide certain coverage for the full length of long-term antibiotic treatment of Lyme disease and related tick-borne illnesses under certain circumstances; and prohibiting certain insurers, nonprofit health service plans, and health maintenance organizations from placing a quantitative limit on or denying coverage for benefits required under the Act.
Requiring the Maryland Department of Health to replace the State Medicaid Management Information System mainframe with a modular system.
Establishing requirements for certain vision benefits, vision benefit plans, and vision benefit discount plans; requiring an insurer or a vision benefit manager to disclose certain information on its website and in certain communications and maintain certain methods of communication for use by participating eye care providers; establishing certain requirements and prohibitions for contracts between insurers or vision benefit managers and participating eye care providers; etc.