HB 1597 establishes a 3-year pilot project (2026-2029) allowing up to five Maryland hospitals to create unregulated operating room space within regulated facilities. Participating hospitals must follow specific criteria: maintain charity care, charge comparable rates to regulated services, reduce costs for Medicaid/Medicare, and avoid duplicating services in regulated spaces. The Health Services Cost Review Commission administers the pilot, requires annual reports on procedures, costs, and impacts on healthcare efficiency, and mandates data sharing from associated surgical centers. This directly affects participating hospitals, patients using unregulated space, and payers (including Medicaid/Medicare), with no changes to existing regulated hospital services.
HB 737 requires health insurance plans (HMOs) to pay non-contracted healthcare providers at minimum rates: 140% of Medicare rates for trauma care, and 125% of the 2019 rate adjusted for inflation for other services. This affects independent doctors, hospitals, and clinics that treat HMO members but aren’t directly contracted with them. The law updates payment standards to better reflect current costs using Medicare’s inflation index, replacing older fixed-rate calculations. It ensures non-contracted providers receive fairer compensation for services rendered to HMO enrollees.
HB 1450 requires health insurance carriers in Maryland to coordinate payments when multiple insurers cover a single claim. Specifically, carriers must identify primary and secondary payors, calculate each payor’s share, and ensure combined payments do not exceed 100% of the claim amount. The bill also limits how long carriers can retroactively deny reimbursement: up to 9 months for other insurers, 18 months for Medicaid or Medicare, and 6 months in other cases, with written explanations required for denials. This directly affects health insurance companies and health care providers who receive payments, aiming to streamline billing and prevent overpayment disputes.
SB 416 sets new minimum reimbursement rates that Maryland health maintenance organizations (HMOs) must pay to nonparticipating health care providers, such as doctors and hospitals not under contract with an HMO, for specific services. For trauma physicians treating trauma patients in designated trauma centers, HMOs must pay the greater of 140% of the Medicare rate (adjusted for inflation) or the 2001 rate (adjusted for inflation). For other services like routine office visits, HMOs must pay at least 125% of the rate they paid in 2019 (adjusted for inflation) or 140% of the Medicare rate from 2008 (adjusted for inflation), whichever is higher. This bill directly affects HMOs and nonparticipating providers by standardizing these minimum payment rates across Maryland.
HB 696 modifies prescription drug coverage for Maryland state retirees based on their hire date. It continues drug benefits for retirees who began state service before July 1, 2011, while ending these benefits for retirees (and their Medicare-eligible spouses/children) who started on or after that date. The bill replaces three existing retiree drug programs with a new reimbursement program covering out-of-pocket costs for eligible retirees who qualify for partial subsidies. It also removes reporting requirements related to Medicare-eligible retirees’ access to services.
SB 134 requires Maryland insurance carriers to issue Medicare supplement policies (Medigap) to specific eligible individuals without denying coverage or charging higher premiums based on health status. It directly affects: (1) people transitioning from Maryland Medicaid to Medicare Part B, (2) individuals who became Medicare-eligible before January 2020, and (3) disabled people under 65 who qualify for Medicare. Key provisions mandate that carriers must sell these policies during defined 63-day enrollment periods following Medicaid disenrollment or qualifying events, and prohibit health-based pricing or denial for plans A and D. The law also requires carriers to offer comparable or lower-benefit plans during birthday renewals starting July 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 140 prohibits individuals from knowingly recruiting, harboring, transporting, or obtaining another person specifically to appropriate their government benefits for personal gain or another's benefit. It directly affects vulnerable populations receiving benefits like Medicare, Medicaid, SNAP, Social Security, or veterans' aid, and targets those exploiting them through coercion (e.g., threats, financial control) or deception. The law defines "exploitation" as illegally using benefits via undue influence, false promises, or isolation, and bans profiting from such exploitation or aiding violations. Violations are felonies punishable by up to 25 years in prison, a $15,000 fine, or both, with each violation treated as a separate offense.
HB 275 requires Maryland insurance carriers to issue Medicare supplement policies without discrimination based on health status during specific enrollment periods. It directly affects Medicare beneficiaries transitioning from Maryland Medical Assistance (Medicaid), disabled individuals under 65 eligible for Medicare, and those with certain federal special enrollment rights. Key provisions include banning denials or higher premiums due to health conditions during a 63-day window after Medicaid termination or qualifying events, and mandating equal or lower-benefit policy options during birthday renewals starting in 2026. The bill ensures these groups can access coverage without health-based barriers, effective July 1, 2026.
SB 340 requires the Governor to allocate at least 3% of funds collected from nursing facilities' Medicaid quality assessments toward the Office of the Long-Term Care Ombudsman's operations in the state budget. It directly affects nursing facilities with 45 or more beds operating in Maryland, which must pay the quality assessment. The bill mandates that these funds - collected quarterly based on non-Medicare patient days - must be used solely for the Ombudsman office, with no reduction to existing funding for this purpose. This creates a dedicated, ongoing funding source to support the Ombudsman's role in investigating resident complaints and advocating for long-term care rights.
