EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb1301*
HOUSE BILL 1301
J5, J1, J4 5lr3342
By: Delegate Rosenberg Delegates Rosenberg, Bagnall, Chisholm, Cullison,
Guzzone, Hill, Hutchinson, S. Johnson, Kaiser, Kerr, Kipke, Lopez,
Martinez, Pena–Melnyk, Ross, Szeliga, and White Holland
Introduced and read first time: February 7, 2025
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 7, 2025
CHAPTER ______
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
2 HOUSE BILL 1301
BY repealing and reenacting, with amendments, 1
Article – Health – General 2
Section 15–101(k) and (l) and 15–103(a)(2)(xxiii) and (xxiv) 3
Annotated Code of Maryland 4
(2023 Replacement Volume and 2024 Supplement) 5
BY adding to 6
Article – Insurance 7
Section 15–861 8
Annotated Code of Maryland 9
(2017 Replacement Volume and 2024 Supplement) 10
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
That the Laws of Maryland read as follows: 12
Article – Health – General 13
15–101. 14
(a) In this title the following words have the meanings indicated. 15
(c) “Facility” means a hospital or nursing facility including an intermediate care 16
facility, skilled nursing facility, comprehensive care facility, or extended care facility. 17
(h) “Program” means the Maryland Medical Assistance Program. 18
(K) “SPECIAL PEDIATRIC HOS PITAL” MEANS A FACILITY IN THE STATE 19
THAT PROVIDES NONACU TE MEDICAL , REHABILITATION , THERAPY, AND 20
PALLIATIVE SERVICES TO INDIVIDUALS: 21
(1) UNDER THE AGE OF 22 YEARS; OR 22
(2) WHO ARE AT LEAST 2 YEARS OLD A ND UNDER THE AGE OF 23 23
YEARS AND HAVE CO –OCCURRING PHYSICAL A ND BEHAVIORAL HEALTH 24
CONDITIONS. 25
[(k)] (L) “Specialty mental health services” means any mental health services 26
other than primary mental health services. 27
[(l)] (M) “Validated home blood pressure monitor” means a blood pressure 28
measurement device that has been validated for accuracy and is listed in the U.S. Blood 29
Pressure Validated Device Listing. 30
15–102.3. 31
HOUSE BILL 1301 3
(M) BEGINNING JANUARY 1, 2026, THE PROVISIONS OF § 15–861 OF THE 1
INSURANCE ARTICLE APPLY TO MANAGED CARE ORGANIZATIONS I N THE SAME 2
MANNER THAT THEY APP LY TO CARRIERS. 3
15–103. 4
(a) (1) The Secretary shall administer the Maryland Medical Assistance 5
Program. 6
(2) The Program: 7
(xxiii) Beginning on July 1, 2025, shall provide, subject to the 8
limitations of the State budget, and as permitted by federal law, coverage for biomarker 9
testing in accordance with § 15–859 of the Insurance Article; [and] 10
(xxiv) Beginning on January 1, 2025, shall provide coverage for 11
prostheses in accordance with § 15–844 of the Insurance Article; AND 12
(XXV) BEGINNING ON JANUARY 1, 2026, SHALL PROVIDE 13
COVERAGE FOR A TRANS FER TO A SPECIAL PED IATRIC HOSPITAL IN A CCORDANCE 14
WITH § 15–861 OF THE INSURANCE ARTICLE. 15
15–157. 16
THE PROGRAM AND THE MARYLAND CHILDREN’S HEALTH PROGRAM MAY 17
NOT REQUIRE PRIOR AU THORIZATION FOR A TR ANSFER TO A SPECIAL PEDIATRIC 18
HOSPITAL. 19
Article – Insurance 20
15–861. 21
(A) IN THIS SECTION, “SPECIAL PEDIATRIC HO SPITAL” HAS THE MEANING 22
STATED IN § 15–101 OF THE HEALTH – GENERAL ARTICLE. 23
(B) THIS SECTION APPLIES TO: 24
(1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 25
PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 26
ON AN EXPENSE –INCURRED BASIS UNDER HEALTH INSURANCE POL ICIES OR 27
CONTRACTS THAT ARE I SSUED OR DELIVERED IN THE STATE; AND 28
(2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 29
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 30
CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE. 31 4 HOUSE BILL 1301
(C) AN ENTITY SUBJECT TO THIS SECTION MAY NOT REQUIRE PRIOR 1
AUTHORIZATION FOR A TRANSFER TO A SPECIA L PEDIATRIC HOSPITAL . 2
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 3
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 4
after January 1, 2026. 5
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 6
January 1, 2026. 7
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.