MD HB1376

Prior authorization cannot be required for patient transfers to special pediatric hospitals under Maryland Medical Assistance Program and Maryland Children's Health Program, though hospitals may request a determination within 2 business days

Maryland Department of Health must adopt regulations by December 31, 2026 establishing a retrospective review process for special pediatric hospitals, including peer-to-peer reconsideration of medical necessity determinations

Retrospective reviews must be conducted by a licensed physician and cover denials of admission or reimbursement for inpatient/outpatient services occurring on or after July 1, 2025

Special pediatric hospitals and referring providers who request retrospective review must be reimbursed for all administrative days at the applicable rate from the date of the medical necessity determination until review completion

Special pediatric hospitals are defined as Maryland facilities providing nonacute medical, rehabilitation, therapy, and palliative services to individuals under age 22, or ages 2-22 with co-occurring physical and behavioral health conditions; effective date is July 1, 2026