MD HB1376

Maryland Medical Assistance Program, Maryland Children's Health Program, managed care organizations, and health insurers must provide prior authorization determinations for transfers to special pediatric hospitals within 3 business days when requested by the hospital or referring provider

Special pediatric hospitals or referring providers may request retrospective review of medical necessity denials, and the review must be conducted even if the patient will not benefit financially from the outcome

Hospitals and referring providers must be reimbursed for all administrative days at the applicable rate from the date of the medical necessity determination until the retrospective review concludes

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

Applies to policies, contracts, and health benefit plans issued, delivered, or renewed in Maryland on or after January 1, 2027