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MarylandSB 09022025 Regular SessionSenateWALLET

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

Sponsored By: Malcolm Augustine (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 referred Maryland patients

These protections apply to Maryland health plans issued, delivered, or renewed on or after January 1, 2026. Care received through the required outside-referral process counts as in-network care for deductibles, copays, and coinsurance. Referred mental health and substance use care cannot cost patients more than in-network care throughout the treatment plan. Insurers cannot require prior approval solely because a provider is outside the network. After approving a referral, insurers cannot impose more coverage reviews than they require for the same in-network benefit. The law does not set payment rates for outside providers.

More specialist access for Maryland patients

Beginning June 1, 2025, Maryland permanently continues existing rules for referrals to and payment for outside specialists. Expanded rules apply to Maryland health plans issued, delivered, or renewed on or after January 1, 2026. Insurers must provide timely outside referrals when patients need specialized care and the network lacks suitable specialists or reasonable access. These referrals include doctors and licensed nonphysician specialists. For mental health and substance use care, access must meet state appointment-wait and travel-distance standards. If referrals do not secure that care, insurers must help find an outside specialist and arrange coverage. Insurers must explain the referral process, record requests, and provide records to the Maryland Insurance Commissioner on request. They must still maintain adequate provider networks.

Sponsors & Cosponsors

Sponsor

  • Malcolm Augustine

    Democratic • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 181 • No: 0

House vote • 3/31/2025

Third Reading Passed

Yes: 134 • No: 0 • Other: 2

Senate vote • 3/12/2025

Third Reading Passed

Yes: 47 • No: 0

Actions Timeline

  1. Approved by the Governor - Chapter 661

    5/20/2025

  2. Returned Passed

    3/31/2025Senate

  3. Third Reading Passed (134-0)

    3/31/2025House

  4. Favorable Adopted Second Reading Passed

    3/28/2025House

  5. Favorable Report by Health and Government Operations

    3/28/2025House

  6. Hearing 3/20 at 1:00 p.m.

    3/15/2025House

  7. Referred Health and Government Operations

    3/13/2025House

  8. Third Reading Passed (47-0)

    3/12/2025Senate

  9. Second Reading Passed with Amendments

    3/11/2025Senate

  10. Favorable with Amendments {253123/1 Adopted

    3/11/2025Senate

  11. Favorable with Amendments Report by Finance

    3/10/2025Senate

  12. Hearing 2/26 at 1:00 p.m.

    2/6/2025Senate

  13. First Reading Finance

    2/3/2025Senate

Bill Text

  • Enacted

    5/20/2025

    PDF

  • Third Reading

    3/11/2025

    PDF

  • First Reading

    2/3/2025

    PDF

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