HB 795 requires Maryland health insurance companies to provide human review for any coverage denial made using artificial intelligence, algorithms, or software tools. Insurers must also report quarterly aggregated data on these AI-related denials, including claim types, member demographics (race, gender, profession), and policy details (individual, group, or exchange plans). These reports must be submitted to the state insurance commissioner and include the total number of AI-related grievances reviewed. The bill directly affects health insurers operating in Maryland and impacts members who face AI-driven coverage decisions.
HB 1603 establishes new regulations for vision benefit plans and discount plans in Maryland. It requires insurers and vision benefit managers to disclose specific information (like legal name, addresses, and regulatory oversight) on their websites and in communications. The bill also sets rules for contracts with eye care providers (optometrists and ophthalmologists), prohibits certain restrictive contract terms, and mandates fair reimbursement procedures. These changes directly affect insurers, vision benefit managers, and eye care providers participating in vision benefit programs. The bill repeals an existing section and adds new sections (15-2201-15-2213) to Maryland’s Insurance Article.
HB 367 prohibits health insurers, nonprofit health plans, and health maintenance organizations in Maryland from charging patients more for physical therapy services (like those for injury recovery) than they charge for an annual physical or wellness visit under the same plan. It requires these insurers to clearly disclose physical therapy coverage details, including limits and conditions, in all plans. The law applies to all health insurance policies issued, delivered, or renewed in Maryland after January 1, 2027. This bill directly affects patients seeking physical therapy and insurers operating in Maryland by standardizing out-of-pocket costs for these services.
HB 88 allows Maryland health insurers, nonprofit health service plans, and health maintenance organizations (HMOs) to join group buying pools for prescription drugs. This enables these entities to collectively purchase medications at potentially lower costs, directly affecting the price of covered drugs for plan members. The bill authorizes participation in such pools for entities providing prescription drug coverage through pharmacy benefit managers. It will take effect October 1, 2026, but does not require participation or guarantee cost savings.
HB 442 requires nursing homes, assisted living facilities, and nurse midwives in Maryland to disclose their professional liability insurance status to residents and potential residents. Specifically, these providers must provide written notice (including electronic communication) if they lack coverage or if coverage has lapsed and not been renewed, with timing requirements: at the first visit for potential residents or at application for admission, and within 30 days of a lapse for current residents. The bill also mandates that facilities without coverage post a conspicuous notice for residents and guests. This law does not change insurance requirements but ensures transparency about coverage gaps. It directly affects residents and potential residents of these care facilities by providing clear, timely disclosure of insurance status.
HB 684 requires health insurance companies to notify members 60 days in advance if a provider (including primary care or behavioral health providers) is removed from their network, unless termination relates to fraud, abuse, or licensure issues. It mandates that members affected by such changes receive a 90-day special enrollment period to continue seeing those providers, along with clear contact information for filing complaints. Insurance companies must also notify the Maryland Insurance Commissioner about network changes at least 60 days before termination and update their access plans within 5 business days of the change. This bill directly affects health insurance members who lose provider access and requires insurers to follow specific transparency and transition procedures.
SB 385 (The Vax Act) requires Maryland’s Secretary of Health to issue evidence-based recommendations for immunizations, screenings, and preventive services, aligning with guidance from major medical organizations like the CDC and U.S. Preventive Services Task Force. It expands pharmacists’ authority to administer vaccines (including those recommended by CDC or the Secretary) to patients aged 3+ after completing specific training and certification, while mandating health insurers to cover these services without cost-sharing. The bill also repeals outdated pertussis-related provisions and updates reporting requirements for pharmacists. This directly affects pharmacists, health insurers, and patients seeking preventive care, aiming to improve access to vaccinations and screenings.
SB 14 adjusts when health coverage becomes effective for small businesses using Maryland's SHOP Exchange during specific special enrollment periods. It allows SHOP Exchanges to set coverage start dates based on when plan selections are received: the first day of the following month if received by the 15th, or the second month if received after the 15th. This applies to enrollments triggered by court-ordered dependents (like child support), death of an employee or dependent, or divorce/legal separation. The bill directly affects small employers and their employees/dependents who qualify for these special enrollment scenarios under Maryland's SHOP program. It takes effect October 1, 2026.
SB 276, the "So Every Body Can Move Act," requires Maryland’s Medicaid program (Maryland Medical Assistance Program) and certain health insurers, nonprofit health plans, and HMOs to cover orthoses (custom braces or supports for musculoskeletal conditions) starting January 1, 2027. It mandates coverage for the devices themselves, components, repairs, and replacements without lifetime limits if a treating provider deems them medically necessary for daily living or work activities. Insurers must follow Medicare’s medical necessity standards and cannot impose higher copays or separate annual dollar limits for this coverage. The bill directly affects Medicaid enrollees and private insurance plan members needing orthotic devices, ensuring broader access to these essential medical supports.
SB 444 repeals an exemption that previously allowed intermediate care facilities offering substance use disorder treatment to change bed capacity without a certificate of need. It creates a new exemption for facilities providing *medically managed residential substance use disorder treatment services*, removing the requirement for a certificate of need if they submit 45 days' written notice to the Commission and the Commission determines the change aligns with the state health plan, improves service efficiency, and serves the public interest. This bill directly affects intermediate care facilities focused on substance use disorder treatment by reducing regulatory barriers for expanding bed capacity or establishing new facilities. The key mechanism is replacing a certificate of need with a streamlined notice-and-review process administered by the Commission. (SB 444, "Certificate of Need - Intermediate Health Care Facilities," 2026)
