Maryland Medical Assistance Program, Maryland Children's Health Program, and Health Insurance - Transfers to Special Pediatric Hospitals - Requirements

HB 1376 requires Maryland's Medicaid (Maryland Medical Assistance Program) and Children's Health Program to provide a review within 3 business days for transfer requests to special pediatric hospitals when requested by the hospital or referring provider. It mandates retrospective reviews if a transfer is denied as "not medically necessary," with providers reimbursed for "administrative days" (days a patient remains without transfer) during the review process. The bill directly affects special pediatric hospitals - facilities serving children under 22 or those 2+ years old with co-occurring physical/behavioral health conditions - and their referring providers. Key provisions include eliminating prior authorization requirements for transfers while establishing strict timelines and reimbursement for administrative delays during appeals. This bill updates existing Medicaid and insurance rules to streamline transfers to specialized pediatric care facilities.