Health Insurance - Access to Nonparticipating Providers - Referrals, Additional Assistance, and Coverage

HB 11 updates Maryland health insurance rules to improve access to nonparticipating health providers, particularly for mental health and substance use disorder services. The bill requires insurers to establish a referral process that helps members connect with specialists not on their provider panel when needed, and to provide additional assistance if standard referrals fail. It also prohibits insurers from demanding prior authorization for scheduling appointments with nonparticipating providers for these services. Additionally, the Maryland Health Care Commission must set reimbursement rates for nonparticipating providers to ensure fair payment. This directly affects health insurance carriers and their members seeking specialized care outside their network.