Overview
Maryland has been a pioneer in state healthcare system reform. Maryland is the only state in the country that regulates rates for hospital services under the Maryland All-Payer Model. Launched in 1971, the all-payer system requires all third-party payers to reimburse hospitals at the same rate. The program was revised in 2014 to include global budgets for all hospitals in the state. In 2018, the Centers for Medicare and Medicaid (CMS) approved Maryland’s goal to expand its all-payer global budgets model beyond hospitals to nursing homes, mental health facilities, and other nonhospital settings under a five-year contract.
Maryland also actively promotes price transparency. The Maryland Health Care Commission (MHCC) operates the state-mandated all-payer claims database (APCD), the Maryland Medical Care Data Base (MCDB). In 2017, the MHCC launched an online pricing tool named “Wear the Cost” that allows Maryland residents to compare the costs of common medical procedures using commercial insurer data. The state also protects patients from surprise medical bills for covered services rendered by providers outside of their health maintenance organization (HMO) by requiring the HMO to pay the provider directly. In addition, state law establishes coverage parity for telehealth services. Most recently, the coverage parity requirement was expanded to include services provided by psychiatrists and psychiatric nurse practitioners.
In healthcare markets, Maryland statute mandates the Maryland Health Connection, an active state-based health insurance exchange under the Affordable Care Act. The federal government approved the state’s Section 1332 state innovation waiver to partially finance the Maryland Reinsurance Program. The plan reimburses up to eighty percent of claims with a $250,000 cap to reduce health insurance premiums and mitigate the impact of high-risk individuals on certain rates in the state’s exchange.
The state regulates provider consolidation by requiring Attorney General notice and approval of all non-profit mergers or acquisitions. Additionally, the state Commission must issue a certificate of need for a health care facility to engage in any conversion, acquisition, consolidation, or change in bed numbers. The state also encourages competition by prohibiting most-favored nation clauses between a health insurance carrier and a provider, as well as general restriction of exclusive contracting provisions under state antitrust law.
In 2024, Maryland enacted legislation related to health insurance utilization review (including requirements for carriers to establish electronic prior authorization processes, provide real-time patient benefit information, and honor prior authorizations), and a transparency requirement for carriers to report the number of members entitled to health care benefits and the number of clean claims for reimbursement processed by a carrier
See below for an overview of existing Maryland state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/11/2023 - 4/10/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1006 – Maryland
Introduced: 2022 Status: Inactive / Dead
Requiring a pharmacy benefits manager or purchaser to maintain a reasonably adequate and accessible network of pharmacies; prohibiting a pharmacy benefits manager or purchaser from requiring a pharmacy or pharmacist to obtain or maintain certain …
HB 1007 – Maryland
Introduced: 2022 Status: Inactive / Dead
Altering the reimbursement levels for drug products that the Maryland Medical Assistance Program is required to establish and that pharmacy benefits managers that contract with a pharmacy on behalf of a managed care organization are …
HB 1008 – Maryland
Introduced: 2022 Status: Inactive / Dead
Prohibiting a pharmacy benefits manager or purchaser from prohibiting a beneficiary from selecting a pharmacy or pharmacist of the beneficiary’s choosing, denying a pharmacy or pharmacist the right to participate in a network, imposing certain …
HB 1009 – Maryland
Introduced: 2022 Status: Inactive / Dead
Altering the application of the prohibition on pharmacy benefits managers reimbursing a pharmacy or pharmacist in an amount less than the pharmacy benefits manager reimburses itself or an affiliate; repealing provisions of law relating to …
HB 1009 (see companion bill SB 700) – Maryland
Introduced: 2019 Status: Inactive / Dead
Repealing the initial cap on participation in a certain waiver; requiring a certain waiver submitted by the Maryland Department of Health to the Centers for Medicare and Medicaid Services to include a request for a …
Md. Code, Health-Gen. § 15-103.5. Review of rates paid to providers: Medical and Pharmacy Assistance Programs – Maryland
Introduced: Status: Enacted
The Department shall review the rates paid to providers under the federal Medicare fee schedule and compare the rates under the Medicare fee schedule to the fee-for-service rates paid to similar providers for the same …
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Md. Code, Health-Gen. § 15-105. Reimbursement rules and regulations: Medical and Pharmacy Assistance Programs – Maryland
Introduced: Status: Enacted
Reimbursement of providers shall comply with the rules and regulations set by the department.
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Md. Code, Health-Gen. § 15-105.2. Reimbursement of health care providers: Medical and Pharmacy Assistance Programs – Maryland
Introduced: Status: Enacted
Subject to the limitations of the State budget and to the extent authorized by federal law or regulation, the Department may authorize coverage of and reimbursement for health care services that are delivered through store …
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Md. Code, Health-Gen. § 15-106. Review of health care provided: Medical and Pharmacy Assistance Programs – Maryland
Introduced: Status: Enacted
In cooperation with the professional organizations whose members provide health care under the Program, the Secretary shall establish a system of review for all health care that is provided. The review shall include a study …
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Md. Code, Health-Gen. § 15-107. Submission of cost reports: Medical and Pharmacy Assistance Programs – Maryland
Introduced: Status: Enacted
The Department may require facilities that participate in the Program to submit cost reports, as defined by the Department, within the time set by the Department.
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United States et al. v. Anthem, Inc., and Cigna Corp. – California, Colorado, Connecticut, District of Columbia, Federal, Georgia, Iowa, Maine, Maryland, New Hampshire, New York, Tennessee, Virginia
District Court: District of Columbia Status: Decided
On April 28, 2017, the D.C. Circuit Court of Appeals affirmed the District Court’s decision to block the proposed $54 billion merger between Anthem and …
Federal Trade Commission and State of Idaho v. St. Luke’s Health System, Ltd and Saltzer Medical Group, P.A. – California, Connecticut, Delaware, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Mississippi, Montana, Nevada, New Mexico, Oregon, Pennsylvania, Tennessee, Washington
District Court: District of Idaho Status: Decided
In March 2013, the FTC and the Idaho Attorney General filed a joint complaint challenging the merger betweenSt. Luke’s Health System, Idaho’s largest health system, …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Association for Accessible Medicines v. Frosh – Maryland
District Court: District of Maryland Status: Decided
In a significant victory for the pharmaceutical industry, the 4th U.S. Circuit Court of Appeals found Maryland’s landmark 2017 law (HB 631), which punishes generic …
Additional Resources
STATE BUDGET
Maryland’s annual budget cycle begins on July 1 and ends on June 30 of the following year. State agencies submit their budget requests to the Governor between August and October, with the Governor submitting a proposed budget to the state legislature on the third Wednesday in January. The legislature typically adopts a budget by the 83rd day of the session.
STATE LEGISLATURE
The state Senate has 47 members and there are 141 members of the House of Delegates. All are elected to four-year terms. The legislature meets in regular session for 90 calendar days each year beginning the second Wednesday in January. Bills do not carry over from year to year.