Healthcare (Insurance)

in committee · Maryland · House of Delegates Feb 19, 2026

HB 737: Health Maintenance Organizations - Payments to Nonparticipating Providers - Reimbursement Rate

HB 737 requires health insurance plans (HMOs) to pay non-contracted healthcare providers at minimum rates: 140% of Medicare rates for trauma care, and 125% of the 2019 rate adjusted for inflation for other services. This affects independent doctors, hospitals, and clinics that treat HMO members but aren’t directly contracted with them. The law updates payment standards to better reflect current costs using Medicare’s inflation index, replacing older fixed-rate calculations. It ensures non-contracted providers receive fairer compensation for services rendered to HMO enrollees.

Topics ✓ HealthcareSupports HealthcareRequires HMOs to pay non-contracted providers higher rates (125-140% of Medicare), improving access by incentivizing provider participation and reflecting current costs.95% confidence

Sub-Topics Insurance Medicare

Track

in committee · Maryland · House of Delegates Mar 3, 2026

HB 1531: Maryland Helping Everyone Afford Life-Saving Treatments and Health Care (HEALTH) Fund - Establishment

HB 1531 establishes the Maryland HEALTH Fund to help individuals cover costs for legally protected health care services under state law, especially where federal restrictions apply. The fund is financed by redirecting $20 million annually from abandoned property sales proceeds (starting fiscal year 2027), plus new premium taxes and portions of sales/use and property tax revenues. It directly assists Maryland residents needing life-saving treatments who face coverage gaps due to federal limitations. The bill creates a dedicated, nonlapsing fund to ensure consistent funding for these health care costs.

Topics ✓ Budget & TaxesSupports Budget & TaxesEstablishes HEALTH Fund using redirected abandoned property funds and new taxes (premium/sales) to fund healthcare coverage, directly advancing state budget allocation for public health services.95% confidence ✓ HealthcareSupports HealthcareEstablishes HEALTH Fund to cover life-saving treatment costs amid federal coverage gaps, directly funding healthcare access through redirected and new revenue streams.90% confidence

Sub-Topics Property Tax Insurance

Track

in committee · Maryland · House of Delegates Mar 13, 2026

HB 1380: Health Insurance - Prescriptions for Gender-Affirming Care and Hormone Therapy - Coverage and Dispensing Requirements

HB 1380 requires health insurers, nonprofit health plans, and health maintenance organizations in Maryland to cover prescriptions for gender-affirming care and hormone therapy (defined as lawful treatment under state law) for up to a 12-month supply per prescription. It prohibits insurers from forcing patients to accept a full 12-month supply if the patient or their provider requests a smaller amount. Pharmacists must dispense qualifying prescriptions (after January 1, 2027) in quantities up to a 12-month supply unless exceptions apply, such as acute drug shortages (limiting to 90 days) or prior coverage in the same plan year. The bill applies to all health plans issued or renewed in Maryland on or after January 1, 2027.

Topics ✓ HealthcareSupports HealthcareMandates insurer coverage for gender-affirming care/hormone therapy, expands access, and protects patient choice per state law, directly advancing healthcare coverage for specified treatments.95% confidence

Sub-Topics Insurance

Track

in committee · Maryland · House of Delegates Mar 10, 2026

HB 1159: Public Health and Health Insurance - Access to Abortion Care - Reporting Requirements

HB 1159 modifies reporting requirements related to abortion care in Maryland. It requires the Department of Health to include specific recommendations in its annual report on the Abortion Care Clinical Training Program to address provider shortages, and mandates the Insurance Commissioner to collect annual data from insurers on funds set aside under federal law (Affordable Care Act) for abortion services. This data must be submitted by January 1 each year to the Senate Finance and House Health committees, covering the previous two calendar years. The bill affects health departments, insurers, and legislative committees, focusing on transparency around abortion care funding and training programs.

Topics ✓ HealthcareSupports HealthcareRequires data collection on abortion care funding and addresses provider shortages, improving access to reproductive healthcare services under public health programs.95% confidence

Sub-Topics Insurance Public Health Women's Health

Track

signed · Maryland · House of Delegates May 26, 2026

HB 1091: Health Insurance and Dental Plan Organizations - Dentists - Assignment of Benefits and Reimbursement of Nonpreferred Providers

HB 1091 requires health insurers and dental plan organizations to directly reimburse dentists not in their network (nonpreferred dentists) when a patient assigns their insurance benefits to the dentist, and prohibits them from blocking such assignments. It also mandates that nonpreferred dentists inform patients about their non-network status, potential out-of-pocket costs, and payment terms before providing care, and submit a disclosure form to the insurer for the assignment. Insurers may still refuse direct payment only in specific cases, such as if the assignment was received too late, an error occurred, the patient withdrew the assignment, or the patient paid the dentist at the time of service. The bill directly affects non-network dentists, their patients, and insurance companies covering dental services.

Topics ✓ HealthcareSupports HealthcareMandates direct reimbursement to nonpreferred dentists, improves patient access to out-of-network care, and requires cost transparency before treatment.90% confidence

Sub-Topics Insurance

signed · Maryland · Senate May 26, 2026

SB 521: Health Insurance - Material Changes to Provider Networks - Notification and Special Enrollment Period

SB 521 requires health insurance companies to notify patients in writing when a primary care provider or behavioral health provider is removed from their network, including the reason for termination and the right to continue seeing that provider for up to 90 days if the removal isn't due to fraud or misconduct. It mandates insurers to provide advance notice (60 days) to Maryland's Insurance Commissioner before terminating provider contracts that materially impact patient access, and to update their access plans within 5 business days after termination. This bill directly affects insured patients who rely on specific providers and health insurance carriers operating in Maryland. The key change is creating a standardized 90-day special enrollment period for affected patients to transition care, improving transparency during network changes.

Topics ✓ HealthcareSupports HealthcareRequires insurers to notify patients of provider removal and allow 90-day continuation, improving patient access and protecting rights in health insurance networks.95% confidence

Sub-Topics Insurance Mental Health Primary Care

signed · Maryland · House of Delegates May 26, 2026

HB 1093: Health Insurance - Provider Panels - Requirements

HB 1093 requires health insurance companies (carriers) to change how they manage provider panels. It removes application fees for providers seeking panel inclusion, mandates specific notice timelines for denials, and requires carriers to update provider directories more frequently. The bill also expands the types of providers carriers cannot restrict (like mental health specialists) and changes rules for reimbursing patients for care from nonparticipating providers. These changes directly affect health insurance companies, doctors/hospitals seeking panel access, and patients navigating provider networks.

Topics ✓ HealthcareSupports HealthcareRemoves provider application fees, expands mental health specialist access, mandates timely denials and updated directories, improving patient access to care.95% confidence

Sub-Topics Insurance Mental Health

in committee · Maryland · Senate Feb 12, 2026

SB 797: Maryland Medical Assistance Program and Health Insurance - Claims for Reimbursement - Downcoding

SB 797 prohibits insurers, nonprofit health service plans, HMOs, and managed care organizations from downcoding healthcare claims (reducing reimbursement without proper justification) in specific situations. The bill requires these entities to provide healthcare providers with a 30-day notice before downcoding, including the specific reason, original and revised codes, and an opportunity to submit additional documentation. It bans practices like using algorithms without clinical review, downcoding based solely on diagnosis codes, or targeting providers treating complex conditions. This directly affects healthcare providers and insurers by establishing clear rules for claim reimbursement and appeal processes.

Topics ✓ HealthcareSupports HealthcareProhibits unjust insurer downcoding, requiring notice and justification to protect provider reimbursement and ensure patient access to care.95% confidence

Sub-Topics Insurance

Track

in committee · Maryland · House of Delegates Feb 13, 2026

HB 1385: Health Insurance - Use of Artificial Intelligence - Human Evaluation

HB 1385 requires health insurers and pharmacy benefit managers using artificial intelligence (AI) for medical treatment reviews (utilization review) to include licensed healthcare professionals in key evaluations. Specifically, it mandates that AI decisions must be reviewed by a licensed professional who can question, modify, or override AI determinations based on a patient’s full medical history and individual circumstances. The bill also requires quarterly reviews of AI performance using human assessments of real-world health outcomes to improve accuracy and safety. These provisions apply to all AI tools used in utilization review processes within Maryland’s health insurance system, effective October 1, 2026.

Topics ✓ HealthcareSupports HealthcareMandates human evaluation of AI medical decisions to ensure patient-specific care and protect patient rights in insurance coverage.95% confidence ✓ TechnologySupports TechnologyMandates human oversight for AI in healthcare decisions, ensuring patient safety and regulatory compliance per consumer protection indicators.85% confidence

Sub-Topics Insurance Prescription Drugs Artificial Intelligence

Track

in committee · Maryland · Senate Feb 12, 2026

SB 779: Better Small Business Employee Benefit Act of 2026

SB 779 exempts professional employer organizations (PEOs) from certain health benefit plan requirements when offering coverage to small employers in Maryland. It directly affects small businesses that use PEOs for employee benefits and the PEOs themselves. The bill requires PEOs to provide written disclosure of plan details to small employers before offering coverage, while removing the need for PEOs to comply with standard health plan mandates like offering plans through the Maryland Health Benefit Exchange. This change simplifies access to health benefits for small employers using PEOs.

Topics ✗ HealthcareOpposes HealthcareExempts PEOs from health plan mandates, reducing required coverage standards for small business employees. This restricts comprehensive benefits per bill language.85% confidence ✗ Labor & EmploymentOpposes Labor & EmploymentRemoves standard health plan mandates protecting worker benefits, weakening employer requirements for PEOs in small business health coverage.85% confidence

Sub-Topics Insurance Tags Small Business

Track