Healthcare (Insurance)

died · Maryland · House of Delegates Mar 13, 2026

HB 1440: Maryland Medical Assistance Program and Health Insurance - Coverage and Utilization Review - Drugs Reviewed by the Prescription Drug Affordability Board

HB 1440 prevents Medicaid plans and certain health insurers from requiring extra approval steps (like prior authorization) or limiting coverage for prescription drugs reviewed by Maryland's Prescription Drug Affordability Board (PDAB). It specifically applies when the PDAB hasn't determined a drug causes cost concerns, has made a policy recommendation, or set a payment limit for the drug. This directly affects patients using these medications by reducing barriers to accessing covered drugs. The bill updates Maryland's health insurance and Medicaid laws to enforce these restrictions on managed care organizations and insurers.

Topics ✓ HealthcareSupports HealthcarePrevents prior authorization barriers for PDAB-reviewed drugs, improving patient access to covered medications without cost concerns or policy limits.92% confidence

Sub-Topics Insurance Medicaid Prescription Drugs

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

HB 886: Certified Peer Recovery Specialists - Coverage Under the Maryland Medical Assistance Program and Health Insurance and Workgroup on Certification

HB 886 requires Maryland's Medicaid program (Maryland Medical Assistance Program) and certain health insurers to cover services provided by certified peer recovery specialists starting January 1, 2027. It directly affects Medicaid beneficiaries, health insurance plans, and certified peer recovery specialists who provide mental health or substance use recovery support. The bill mandates coverage for these services in any setting and creates a workgroup to improve certification processes for specialists. The workgroup, convened by the Maryland Department of Health, must report on streamlining certification by 2026. This policy change ensures standardized coverage for a specific type of recovery support service under state health programs.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid/insurers to cover peer recovery specialist services, expanding mental health access under Medicaid, directly advancing healthcare coverage.95% confidence

Sub-Topics Insurance Mental Health Substance Abuse

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signed · Maryland · Senate May 26, 2026

SB 813: Health Insurance and Dental Plan Organizations - Dentists - Assignment of Benefits and Reimbursement of Nonpreferred Providers

SB 813 prohibits dental insurers and plan organizations from blocking direct payments to dentists (nonpreferred providers) when patients assign benefits to them, instead of paying patients who then pay dentists. It requires dentists to provide patients with clear cost disclosures - including potential balance billing - before services and submit a disclosure form to insurers. The bill applies specifically to dental care under Maryland law, amending sections 14-205.3 and adding 14-410.1 to the Insurance Article. Insurers may refuse direct payment only in limited cases, such as if a patient paid the dentist upfront or withdrew assignment after payment. This aims to simplify reimbursement for dental patients and dentists outside insurance networks.

Topics ✓ HealthcareSupports HealthcareProhibits insurer barriers to direct dentist payments and mandates cost disclosures, enhancing patient access and transparency in dental insurance coverage.90% confidence

Sub-Topics Insurance

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

HB 1435: Health Insurance - Required Coverage - Hormone-Related Care

HB 1435 requires Maryland health insurance companies, nonprofit health plans, and health maintenance organizations to cover hormone-related care for perimenopausal and menopausal symptoms. This includes hormone therapy, hormone-modulating medications, related lab testing, and clinical visits, with coverage not denied based on diagnosis (like menopause symptoms), age, or prior treatment history. The bill prohibits extra approval steps, stricter limitations, or higher costs for this care compared to similar treatments. It also mandates that coverage decisions follow evidence-based guidelines and the treating provider’s clinical judgment, ensuring timely access to care.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for hormone-related care, prohibits denials based on diagnosis/age, and expands access to menopausal health services per bill summary.95% confidence

Sub-Topics Insurance

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

HB 1153: Maryland Medical Assistance Program and Health Insurance - Claims for Reimbursement - Downcoding

HB 1153 prohibits health insurers, nonprofit health service plans, HMOs, and managed care organizations in Maryland from unilaterally lowering medical claim payments (downcoding) without clinical justification. The bill requires these entities to notify providers within 30 days if they intend to downcode, including specific reasons, references to clinical guidelines, and the original vs. revised codes. It bans practices like downcoding based solely on diagnosis codes, using AI without reviewing medical records, or targeting providers treating complex conditions, and mandates emergency claims be downcoded based on documented symptoms - not final diagnoses. A downcoding decision resulting in nonpayment is treated as a coverage denial, allowing providers to appeal under existing law.

Topics ✓ HealthcareSupports HealthcareProhibits insurers from unjust downcoding without clinical justification, requiring notice and rationale to protect provider reimbursement and maintain patient access to care.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentProtects healthcare providers' compensation by prohibiting unjust downcoding, aligning with worker pay rights in Labor & Employment85% confidence

Sub-Topics Insurance

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in committee · Maryland · House of Delegates Feb 26, 2026

HB 917: Health Insurance - Retroactive Denial of Reimbursement

HB 917 limits when health insurance companies in Maryland can deny payment for past medical services (retroactive denial of reimbursement). It restricts such denials to cases involving coordination of benefits within 18 months of payment or after insurers provide providers with training on billing standards within 3 months. The bill requires insurers to give providers written explanations with supporting details for any denial and prohibits denials based on service outcomes or without first discussing the circumstances with the provider. It also mandates that insurers developing retroactive denial policies create training plans for healthcare providers on reimbursement protocols. The law applies to all insurance policies effective January 1, 2027.

Topics ✓ HealthcareSupports HealthcareBill limits retroactive insurance denials, requires written explanations, prohibits arbitrary denials. Protects providers and ensures fair reimbursement, advancing patient access and insurance coverage.90% confidence

Sub-Topics Insurance

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died · Maryland · Senate Mar 16, 2026

SB 785: Public Health and Health Insurance - Access to Abortion Care - Reporting Requirements

SB 785 requires the Maryland Department of Health to include specific recommendations in its annual report on the Abortion Care Clinical Training Program, aiming to address provider shortages for abortion services. It also mandates the Maryland Insurance Commissioner to collect annual data from insurers and health plans about federal Affordable Care Act segregated accounts, including receipts, disbursements, and balances. The Commissioner must submit this aggregated data to the Senate Finance and House Health Committees by January 1 each year, using data from the previous two years. This bill directly affects state health agencies, insurers, and legislative committees by creating new reporting obligations related to abortion care access and health insurance data transparency.

Topics ✓ HealthcareSupports HealthcareBill addresses abortion care access shortages via provider training program recommendations, directly improving patient access to healthcare services.95% confidence

Sub-Topics Insurance Public Health Women's Health

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passed · Maryland · House of Delegates Mar 18, 2026

HB 1068: Health Insurance - Special Enrollment Period for Newly Hired Employees of Small Businesses

HB 1068 requires health insurance carriers in Maryland to provide a 60-day special enrollment period for individuals who become newly hired by small businesses that do not offer employer-sponsored health plans. This applies to people purchasing coverage through the state’s health insurance marketplace (Individual Exchange) or outside it. The special enrollment period begins on the first day of employment and allows new hires to enroll in health insurance without waiting for the standard open enrollment period. The law takes effect January 1, 2027, directly benefiting newly employed workers at small businesses without health benefits.

Topics ✓ HealthcareSupports HealthcareBill creates 60-day special enrollment for new hires at small businesses without employer plans, expanding health insurance access without waiting for open enrollment.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentProvides immediate health insurance access for new hires at small businesses, expanding worker benefits under employment standards.90% confidence

Sub-Topics Insurance

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signed · Maryland · House of Delegates May 26, 2026

HB 746: Maryland Medical Assistance Program and Health Insurance - Collaborative Care Model - Cost Sharing Prohibition and Coverage Requirements

HB 746 prohibits Maryland Medicaid (Medical Assistance Program) and private health insurers from charging copays, coinsurance, or deductibles for services delivered under the Collaborative Care Model. This model integrates mental/behavioral health services into primary care through coordinated care, regular outcome monitoring, and specialist consultations. The law applies to all Medicaid recipients and covers services under private health insurance plans (including nonprofit health plans and health maintenance organizations) issued in Maryland, with an exception for high-deductible health plans. It takes effect January 1, 2027, ensuring no cost-sharing for these integrated care services.

Topics ✓ HealthcareSupports HealthcareProhibits cost-sharing for integrated mental health services under Collaborative Care Model, improving access to behavioral health within primary care for Medicaid and private insurance holders.95% confidence

Sub-Topics Insurance Medicaid Mental Health

passed · Maryland · Senate Mar 25, 2026

SB 608: Maryland Medical Assistance Plan and Health Insurance - Pharmacogenomic Testing - Required Coverage

SB 608 requires Maryland's Medicaid program (Maryland Medical Assistance Plan) and certain health insurers, nonprofit health plans, and health maintenance organizations to cover single-gene and multigene pharmacogenomic testing starting July 1, 2027. This applies specifically when a treating provider orders the test for patients with depression or anxiety who are considering a medication change, dose adjustment, or addition with a known gene-drug interaction. The bill limits prior authorization requirements to ensure timely access, mandating clear pathways, minimal documentation, and sufficient time for submissions without creating unnecessary delays. Noncompliance could result in penalties of up to $10,000 per violation plus $1,000 daily until resolved. The law aims to improve medication safety and effectiveness by making this genetic testing accessible for targeted patient groups.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid/insurers to cover pharmacogenomic testing for depression/anxiety treatment adjustments, expanding access to personalized mental health care without prior authorization barriers.95% confidence

Sub-Topics Insurance Medicaid

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