EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTING LAW .
[Brackets] indicate matter deleted from existing law.
*hb1301*
HOUSE BILL 1301
J5, J1, J4 5lr3342
By: Delegate Rosenberg
Introduced and read first time: February 7, 2025
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Maryland Medical Assistance Program, Maryland Children’s Health Program, 2
and Health Insurance – Transfers to Special Pediatric Hospitals – Prior 3
Authorizations 4
FOR the purpose of prohibiting the Maryland Medical Assistance Program, the Maryland 5
Children’s Health Program, managed care organizations, and certain health 6
insurers, nonprofit health service plans, and health maintenance organizations from 7
requiring prior authorization for a transfer to a special pediatric hospital; and 8
generally relating to health insurance coverage for transfers to special pediatric 9
hospitals. 10
BY repealing and reenacting, without amendments, 11
Article – Health – General 12
Section 15–101(a), (c), and (h) and 15–103(a)(1) 13
Annotated Code of Maryland 14
(2023 Replacement Volume and 2024 Supplement) 15
BY adding to 16
Article – Health – General 17
Section 15–101(k), 15–102.3(m), 15–103(a)(2)(xxv), and 15–157 18
Annotated Code of Maryland 19
(2023 Replacement Volume and 2024 Supplement) 20
BY repealing and reenacting, with amendments, 21
Article – Health – General 22
Section 15–101(k) and (l) and 15–103(a)(2)(xxiii) and (xxiv) 23
Annotated Code of Maryland 24
(2023 Replacement Volume and 2024 Supplement) 25
BY adding to 26
Article – Insurance 27 2 HOUSE BILL 1301
Section 15–861 1
Annotated Code of Maryland 2
(2017 Replacement Volume and 2024 Supplement) 3
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 4
That the Laws of Maryland read as follows: 5
Article – Health – General 6
15–101. 7
(a) In this title the following words have the meanings indicated. 8
(c) “Facility” means a hospital or nursing facility including an intermediate care 9
facility, skilled nursing facility, comprehensive care facility, or extended care facility. 10
(h) “Program” means the Maryland Medical Assistance Program. 11
(K) “SPECIAL PEDIATRIC HOS PITAL” MEANS A FACILITY THA T PROVIDES 12
NONACUTE MEDICAL , REHABILITATION , THERAPY, AND PALLIATIVE SERVI CES TO 13
INDIVIDUALS: 14
(1) UNDER THE AGE OF 22 YEARS; OR 15
(2) WHO ARE AT LEAST 2 YEARS OLD AND UNDER THE AGE OF 23 16
YEARS AND HAVE CO –OCCURRING PHYSICAL A ND BEHAVIORAL HEALTH 17
CONDITIONS. 18
[(k)] (L) “Specialty mental health services” means any mental health services 19
other than primary mental health services. 20
[(l)] (M) “Validated home blood pressure monitor” means a blood pressure 21
measurement device that has been validated for accuracy and is listed in the U.S. Blood 22
Pressure Validated Device Listing. 23
15–102.3. 24
(M) BEGINNING JANUARY 1, 2026, THE PROVISIONS OF § 15–861 OF THE 25
INSURANCE ARTICLE APPLY TO MANA GED CARE ORGANI ZATIONS IN THE SAME 26
MANNER THAT THEY APP LY TO CARRIERS. 27
15–103. 28
(a) (1) The Secretary shall administer the Maryland Medical Assistance 29
Program. 30
HOUSE BILL 1301 3
(2) The Program: 1
(xxiii) Beginning on July 1, 2025, shall provide, subject to the 2
limitations of the State budget, and as permitted by federal law, coverage for biomarker 3
testing in accordance with § 15–859 of the Insurance Article; [and] 4
(xxiv) Beginning on January 1, 2025, shall provide coverage for 5
prostheses in accordance with § 15–844 of the Insurance Article; AND 6
(XXV) BEGINNING ON JANUARY 1, 2026, SHALL PROVIDE 7
COVERAGE FOR A TRANSFER TO A SPECIAL PEDIATRIC HOSPITAL IN ACCORDAN CE 8
WITH § 15–861 OF THE INSURANCE ARTICLE. 9
15–157. 10
THE PROGRAM AND THE MARYLAND CHILDREN’S HEALTH PROGRAM MAY 11
NOT REQUIRE PRIOR AUTHOR IZATION FOR A TRANSF ER TO A SPECIAL PEDI ATRIC 12
HOSPITAL. 13
Article – Insurance 14
15–861. 15
(A) IN THIS SECTION, “SPECIAL PEDIATRIC HOS PITAL” HAS THE MEANING 16
STATED IN § 15–101 OF THE HEALTH – GENERAL ARTICLE. 17
(B) THIS SECTION APPLIES TO: 18
(1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 19
PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 20
ON AN EXPENSE –INCURRED BASIS UNDER HEALTH INSURANCE POL ICIES OR 21
CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE; AND 22
(2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 23
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 24
CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE. 25
(C) AN ENTITY SUBJECT TO THIS SECTION MAY NOT REQUIRE PRIOR 26
AUTHORIZATION FOR A TRANSFER TO A SPECIA L PEDIATRIC HOSPITAL . 27
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 28
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 29
after January 1, 2026. 30
4 HOUSE BILL 1301
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 1
January 1, 2026. 2