Bill > HB1376

This bill requires the Maryland Medical Assistance Program (Medicaid), the Maryland Children's Health Program (CHIP), managed care organizations (which are health plans that manage care for enrollees), and certain other health insurers and health maintenance organizations to provide a prior authorization determination for a transfer to a special pediatric hospital, which is a facility providing specialized care to individuals under 23 years old with specific medical needs, within three business days of a request from the hospital or a referring healthcare provider. If a special pediatric hospital or referring provider disagrees with a determination that a transfer is not medically necessary (meaning the care is directly related to treatment, consistent with good medical practice, and not just for convenience), they can request a retrospective review, and will be reimbursed for administrative days during that review process. The bill also clarifies that these requirements apply to various health plans and policies issued or renewed on or after January 1, 2027, and the act itself takes effect on January 1, 2027.

Health and Social Services

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/HB1376?ys=2026RS