Explore Bills

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.

Authorizing certain insurers, nonprofit health service plans, and health maintenance organizations to join bulk purchasing pools for prescription drugs.

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 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 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.

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.

Altering the reimbursement rate at which health maintenance organizations are required to pay certain nonparticipating health care providers for services.

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.

Altering the reimbursement rate at which health maintenance organizations are required to pay certain nonparticipating health care providers for services.

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 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 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 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.

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.

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 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 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 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 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.

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 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 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 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.

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.