Bill > HB11

This bill modifies health insurance regulations to improve patient access to specialized medical care, particularly for mental health and substance use disorder services. The legislation requires health insurance carriers to establish a procedure allowing members to request referrals to specialists or nonphysician specialists outside their provider panel under specific circumstances. These circumstances include cases where the carrier lacks a specialist with appropriate expertise to treat a specific condition, cannot provide timely access to such a specialist, or cannot offer mental health or substance use disorder services within reasonable appointment waiting times and travel distances. The bill mandates that carriers address referral requests promptly and provide additional assistance to members seeking mental health or substance use disorder services if initial referral methods are unsuccessful. Furthermore, once a referral is approved, carriers cannot impose more stringent utilization review requirements than they would for in-network providers, and they must treat out-of-network specialist services as if they were in-network for calculating member costs, especially for mental health and substance use disorder treatments. The bill also removes the previous sunset provision that would have terminated these provisions on June 30, 2025, effectively making the referral and access requirements permanent, with implementation set to begin on January 1, 2026.

Budget and Finance, Health and Social Services

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/HB0011?ys=2025RS