Maryland 2025 Regular Session

Maryland House Bill HB1341 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4	4	[Brackets] indicate matter deleted from existing law.
5	5	hb1341
6	6
7	7	HOUSE BILL 1341
8	8	J5 5lr2202
9	9
10	10	By: Delegates Woods, Bhandari, Kaiser, Kaufman, J. Long, Roberson, Roberts,
11	11	Taylor, and White Holland
12	12	Introduced and read first time: February 7, 2025
13	13	Assigned to: Health and Government Operations
14	14
15	15	A BILL ENTITLED
16	16
17	17	AN ACT concerning 1
18	18
19	19	Health Insurance – Appeals and Adverse Decisions – Call Centers, Notification 2
20	20	Requirements, and Required Survey 3
21	21
22	22	FOR the purpose of requiring health insurance carriers to operate a call center for appeals 4
23	23	and adverse decisions, include certain information in a certain manner in the written 5
24	24	notice of adverse decisions required to be sent to members, and conduct an annual 6
25	25	survey on member experiences with the internal grievance process; and generally 7
26	26	relating to health insurance appeals and adverse decisions. 8
27	27
28	28	BY repealing and reenacting, with amendments, 9
29	29	Article – Insurance 10
30	30	Section 15–10A–02(e), (f), and (l) and 15–10A–06(a)(3)(viii) and (4) 11
31	31	Annotated Code of Maryland 12
32	32	(2017 Replacement Volume and 2024 Supplement) 13
33	33
34	34	BY adding to 14
35	35	Article – Insurance 15
36	36	Section 15–10A–02(l) and 15–10A–06(a)(5) 16
37	37	Annotated Code of Maryland 17
38	38	(2017 Replacement Volume and 2024 Supplement) 18
39	39
40	40	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 19
41	41	That the Laws of Maryland read as follows: 20
42	42
43	43	Article – Insurance 21
44	44
45	45	15–10A–02. 22
46	46
47	47	(e) Each carrier shall: 23
48	48	2 HOUSE BILL 1341
49	49
50	50
51	51	(1) file for review with the Commissioner and submit to the Health 1
52	52	Advocacy Unit a copy of its internal grievance process established under this subtitle; [and] 2
53	53
54	54	(2) file any revision to the internal grievance process with the 3
55	55	Commissioner and the Health Advocacy Unit at least 30 days before its intended use; AND 4
56	56
57	57	(3) OFFER A 24–HOUR CALL CENTER FOR MEMBERS WHO WISH TO 5
58	58	APPEAL AN ADVERSE DE CISION, OPERATED BY STAFF ME MBERS WHO RECEIVE 6
59	59	ANNUAL TRAINING IN STATE INSURANCE LAWS AND REGULATIONS . 7
60	60
61	61	(f) (1) For nonemergency cases, when a carrier renders an adverse decision, 8
62	62	the carrier shall: 9
63	63
64	64	(i) inform the member, the member’s representative, or the health 10
65	65	care provider acting on behalf of the member of the adverse decision: 11
66	66
67	67	1. orally by telephone; or 12
68	68
69	69	2. with the affirmative consent of the member, the member’s 13
70	70	representative, or the health care provider acting on behalf of the member, by text, 14
71	71	facsimile, e–mail, an online portal, or other expedited means; and 15
72	72
73	73	(ii) send, within 5 working days after the adverse decision has been 16
74	74	made, a written notice to the member, the member’s representative, and a health care 17
75	75	provider acting on behalf of the member that: 18
76	76
77	77	1. states in detail in clear, understandable language the 19
78	78	specific factual bases for the carrier’s decision and the reasoning used to determine that the 20
79	79	health care service is not medically necessary and did not meet the carrier’s criteria and 21
80	80	standards used in conducting the utilization review; 22
81	81
82	82	2. provides the specific reference, language, or requirements 23
83	83	from the criteria and standards, including any interpretive guidelines, on which the 24
84	84	decision was based, and may not solely use: 25
85	85
86	86	A. generalized terms such as “experimental procedure not 26
87	87	covered”, “cosmetic procedure not covered”, “service included under another procedure”, or 27
88	88	“not medically necessary”; or 28
89	89
90	90	B. language directing the member to review the additional 29
91	91	coverage criteria in the member’s policy or plan documents; 30
92	92
93	93	3. states the name, business address, and business telephone 31
94	94	number of: 32
95	95
96	96	A. if the carrier is a health maintenance organization, the 33
97	97	medical director or associate medical director, as appropriate, who made the decision; or 34 HOUSE BILL 1341 3
98	98
99	99
100	100
101	101	B. if the carrier is not a health maintenance organization, the 1
102	102	designated employee or representative of the carrier who has responsibility for the carrier’s 2
103	103	internal grievance process and the physician who is required to make all adverse decisions 3
104	104	as required in § 15–10B–07(a) of this title; 4
105	105
106	106	4. gives written details of the carrier’s internal grievance 5
107	107	process and procedures under this subtitle; and 6
108	108
109	109	5. includes the following information: 7
110	110
111	111	A. that the member, the member’s representative, or a health 8
112	112	care provider on behalf of the member has a right to file a complaint with the Commissioner 9
113	113	within 4 months after receipt of a carrier’s grievance decision; 10
114	114
115	115	B. that a complaint may be filed without first filing a 11
116	116	grievance if the member, the member’s representative, or a health care provider filing a 12
117	117	grievance on behalf of the member can demonstrate a compelling reason to do so as 13
118	118	determined by the Commissioner; 14
119	119
120	120	C. the Commissioner’s address, telephone number, and 15
121	121	facsimile number; 16
122	122
123	123	D. a statement IN 14 POINT BOLD FONT STAT ING THAT 17
124	124	THE DECISION IS AN I NSURANCE DENIAL AND that the Health Advocacy Unit is 18
125	125	available to assist the member or the member’s representative in both mediating and filing 19
126	126	a grievance under the carrier’s internal grievance process; [and] 20
127	127
128	128	E. the address, telephone number, facsimile number, and 21
129	129	electronic mail address of the Health Advocacy Unit IN 14 POINT BOLD FONT; 22
130	130
131	131	F. THE FOLLOWING STATEM ENT IN 14 POINT BOLD FONT 23
132	132	PLACED AT THE TOP OF THE NOTICE: “THIS IS AN INSURANCE DENIAL. FOR FREE 24
133	133	HELP, IF YOU DON’T UNDERSTAND THIS DO CUMENT OR YOU WOULD LIKE HELP 25
134	134	APPEALING THE DECISI ON, CONTACT THE MARYLAND INSURANCE 26
135	135	ADMINISTRATION AT (INSERT THE NUMBER FO R THE ADMINISTRATION ’S MEDICAL 27
136	136	NECESSITY AND EMERGENCY APPEALS HOTLINE) OR THROUGH (INSERT THE 28
137	137	ADDRESS FOR THE ADMINISTRATION ’S WEBSITE).”; 29
138	138
139	139	G. A QR CODE THAT LINKS TO A SHORT VIDEO 30
140	140	PROVIDING GUIDANCE F OR MEMBERS ON NAVIGAT ING THE GRIEVANCE AN D 31
141	141	APPEALS PROCESS ; AND 32
142	142
143	143	H. THE TELEPHONE NUMBER OF THE CALL CENTER 33
144	144	REQUIRED UNDER SUBSE CTION (E)(3) OF THIS SECTION . 34 4 HOUSE BILL 1341
145	145
146	146
147	147
148	148	(2) The business telephone number included in the notice as required 1
149	149	under paragraph (1)(ii)3 of this subsection must be a dedicated number for adverse 2
150	150	decisions and may not be the general customer call number for the carrier. 3
151	151
152	152	(3) THE COMMISSIONER SHALL DE VELOP THE VIDEO REQU IRED 4
153	153	UNDER PARAGRAPH (1)(II)5G OF THIS SUBSECTION . 5
154	154
155	155	(L) ON AN ANNUAL BASIS, EACH CARRIER SHALL : 6
156	156
157	157	(1) SURVEY MEMBERS ON TH EIR EXPERIENCES WITH THE CARRIER’S 7
158	158	INTERNAL GRIEVANCE P ROCESS, INCLUDING EXPERIENCE S WITH THE CALL 8
159	159	CENTERS REQUIRED UND ER SUBSECTION (E)(3) OF THIS SECTION; AND 9
160	160
161	161	(2) SUBMIT THE RESULTS O F THE SURVEY TO THE COMMISSIONER . 10
162	162
163	163	[(l)] (M) (1) [Nothing in this] THIS subtitle [prohibits] DOES NOT 11
164	164	PROHIBIT a carrier from delegating its internal grievance process to a private review agent 12
165	165	that has a certificate issued under Subtitle 10B of this title and is acting on behalf of the 13
166	166	carrier. 14
167	167
168	168	(2) If a carrier delegates its internal grievance process to a private review 15
169	169	agent, the carrier shall be: 16
170	170
171	171	(i) bound by the grievance decision made by the private review 17
172	172	agent acting on behalf of the carrier; and 18
173	173
174	174	(ii) responsible for a violation of any provision of this subtitle 19
175	175	regardless of the delegation made by the carrier under paragraph (1) of this subsection. 20
176	176
177	177	15–10A–06. 21
178	178
179	179	(a) On a quarterly basis, each carrier shall submit to the Commissioner, on the 22
180	180	form the Commissioner requires, a report that describes: 23
181	181
182	182	(3) the activities of the carrier under this subtitle, including: 24
183	183
184	184	(viii) the number of requests made and granted under § 15–831(c)(1) 25
185	185	and (2) of this title; [and] 26
186	186
187	187	(4) the number and outcome of all other cases that are not subject to 27
188	188	activities of the carrier under this subtitle that resulted from an adverse decision involving 28
189	189	the length of stay for inpatient hospitalization as related to the medical procedure involved; 29
190	190	AND 30
191	191	HOUSE BILL 1341 5
192	192
193	193
194	194	(5) THE AVERAGE HOLD TIME AND TOTAL TIME FOR CALLS MADE TO 1
195	195	THE CARRIER ’S GRIEVANCE AND APPE AL CALL CENTERS , SEGREGATED BY 2
196	196	EMERGENCY AND NONEME RGENCY CASES . 3
197	197
198	198	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 4
199	199	October 1, 2025. 5