Bill > SB902

This bill modifies Maryland's health insurance regulations to improve access to medical specialists for patients, particularly in mental health and substance use disorder care. It requires health insurance carriers to establish a procedure allowing members to request referrals to specialists or nonphysician specialists outside the carrier's provider panel under specific circumstances, such as when the carrier lacks a specialist with the appropriate expertise or cannot provide timely access to care. The bill eliminates the previous sunset provision that would have terminated these provisions on June 30, 2025, making them permanent. When a member is approved for a referral to an out-of-network specialist, the carrier cannot impose additional utilization review requirements beyond what would be required for an in-network provider. For mental health and substance use disorder services, carriers must provide additional assistance to members in identifying and arranging coverage if they cannot access services through the standard referral process. The bill also ensures that members will not face higher out-of-pocket costs for these out-of-network specialist services, effectively treating them as if they were in-network services. These provisions aim to improve healthcare access and reduce barriers to specialized medical care for patients in Maryland.

Budget and Finance, Health and Social Services

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/SB0902?ys=2025RS