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MarylandHB 00112025 Regular SessionHouseWALLET

Health Insurance - Access to Nonparticipating Providers - Referrals, Additional Assistance, and Coverage

Sponsored By: Sheree Sample-Hughes (Democratic)

Signed by Governor

Health - InsuranceHealth Maintenance OrganizationsHealth Care CommissionHealth Insurance -see also- ACA; HMOs; MCOsHealth Maintenance Organizations -see also- Manage Care OrgsHealth Occupations -see also- (specific health occupations)Medical TreatmentsMeetings -see also- Hearings; Open GovernmentMental and Behavioral Health -see also- Aut; Cogn; Dev; etc.Nonprofit OrganizationsOpen GovernmentReimbursement RatesSubstance AbuseSubstance Abuse TreatmentSunset

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

In-network costs for approved outside care

These protections apply to Maryland state-regulated health plans issued, delivered, or renewed after January 1, 2026. Care received through the law's outside-network referral process uses in-network rules for deductibles, copays, and coinsurance. Referred mental health and substance use care cannot cost members more than in-network care throughout the treatment plan. After approval, insurers cannot use this process to require prior authorization for scheduling, paying the specialist, or continuing established treatment. Insurers also cannot require more reviews of whether care is needed than they require for the same in-network benefit.

More specialist access for Maryland patients

Maryland's core referral rules apply to state-regulated health plans issued, delivered, or renewed after January 1, 2026. Insurers must offer outside-network referrals when members need specialized care and qualified network specialists are unavailable or not reasonably accessible. Mental health and substance use care also qualify when insurers cannot meet regulated appointment-wait and travel-distance standards. If that referral process fails, insurers must help members find outside specialists and arrange coverage. Insurers must explain the process, handle requests promptly based on medical needs, and document requests for the Maryland Insurance Commissioner. Referrals cannot replace an adequate provider network, and the law removes the former end date for referral and reimbursement protections.

Sponsors & Cosponsors

Sponsor

  • Sheree Sample-Hughes

    Democratic • House

Cosponsors

  • Tiffany T. Alston

    Democratic • House

  • Heather Bagnall

    Democratic • House

  • Harry Bhandari

    Democratic • House

  • Brian Chisholm

    Republican • House

  • Bonnie Cullison

    Democratic • House

  • Pam Lanman Guzzone

    Democratic • House

  • Terri L. Hill

    Democratic • House

  • Thomas S. Hutchinson

    Republican • House

  • Anne R. Kaiser

    Democratic • House

  • Kenneth Kerr

    Democratic • House

  • Nicholaus R. Kipke

    Republican • House

  • Lesley J. Lopez

    Democratic • House

  • Matthew Morgan

    Republican • House

  • Ashanti Martinez

    Democratic • House

  • Joseline A. Peña-Melnyk

    Democratic • House

  • Teresa E. Reilly

    Republican • House

  • Samuel I. Rosenberg

    Democratic • House

  • Steve Johnson

    Democratic • House

  • Kathy Szeliga

    Republican • House

  • Deni Taveras

    Democratic • House

  • Jennifer White Holland

    Democratic • House

  • Jamila J. Woods

    Democratic • House

  • Teresa Woorman

    Democratic • House

Roll Call Votes

All Roll Calls

Yes: 180 • No: 0

Senate vote • 3/31/2025

Third Reading Passed

Yes: 47 • No: 0

House vote • 2/27/2025

Third Reading Passed

Yes: 133 • No: 0 • Other: 1

Actions Timeline

  1. Approved by the Governor - Chapter 660

    5/20/2025

  2. Returned Passed

    4/1/2025House

  3. Third Reading Passed (47-0)

    3/31/2025Senate

  4. Favorable Adopted Second Reading Passed

    3/25/2025Senate

  5. Favorable Report by Finance

    3/24/2025Senate

  6. Referred Finance

    2/28/2025Senate

  7. Third Reading Passed (133-0)

    2/27/2025House

  8. Second Reading Passed with Amendments

    2/25/2025House

  9. Favorable with Amendments {273927/1 Adopted

    2/25/2025House

  10. Favorable with Amendments Report by Health and Government Operations

    2/24/2025House

  11. Hearing 1/30 at 1:00 p.m.

    1/10/2025House

  12. First Reading Health and Government Operations

    1/8/2025House

  13. Pre-filed

    10/18/2024House

Bill Text

  • Enacted

    5/20/2025

    PDF

  • Third Reading

    2/25/2025

    PDF

  • First Reading

    1/8/2025

    PDF

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