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 recent terms, Maryland has been active in regulating prescription drug costs, including pharmaceutical price transparency. In 2017, Maryland passed legislation to combat price gouging in essential generic or off-patent drugs. The legislation proposed to give Maryland’s Attorney General the power to hold companies accountable for unconscionable increases in prices. However, the 4th U.S. Circuit Court of Appeals deemed the law unconstitutional for violating the dormant commerce clause. The state appealed that decision, but the Supreme Court denied certiorari, effectively striking down the landmark law.
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 1059 – Maryland
Introduced: 2019 Status: Inactive / Dead
Requiring the Maryland Health Care Commission to publish a certain notice of the closing or partial closing of a certain health care facility within a certain time period; requiring the Commission to ensure that a …
HB 1087 (see companion bill SB 871) – Maryland
Introduced: 2019 Status: Inactive / Dead
Providing that the General Assembly finds that all State residents have a right to health care; providing it is the intent of the General Assembly to establish a comprehensive universal single-payer health care coverage program …
HB 1098 – Maryland
Introduced: 2019 Status: Enacted
Health Insurance – Maryland Health Benefit Exchange – Small Business Tax Credit Subsidy: Altering the contents of the Maryland Health Benefit Exchange Fund; authorizing the Maryland Health Benefit Exchange, in consultation with the Maryland Insurance …
HB 1100 – Maryland
Introduced: 2020 Status: Enacted
Requiring the Prescription Drug Affordability Board to meet four times per year instead of every 6 weeks; repealing the requirement that the Board hire general counsel; providing that the Attorney General is the legal advisor …
HB 1108 – Maryland
Introduced: 2023 Status: Inactive / Dead
Altering the process by which health insurance carriers and managed care organizations determine participation by providers on provider panels; and requiring internal review systems to include grievances involving the rejection of a provider’s application to …
HB 1169 (see companion bill SB 774) – Maryland
Introduced: 2020 Status: Enacted
Health Services Cost Review Commission – Community Benefits – Reporting. Requiring the Health Services Cost Review Commission to establish a Community Benefit Reporting Workgroup; requiring the Commission to adopt certain regulations relating to the community …
HB 1307 (see companion bill SB 1017) – Maryland
Introduced: 2020 Status: Enacted
Pharmacy Benefits Managers – Credentialing and Reimbursement. Prohibiting a pharmacy benefits manager from requiring a certain pharmacy or pharmacist to obtain certain credentialing as a condition for participating in a certain network with certain frequency …
HB 1349 (see companion bill SB 1079) – Maryland
Introduced: 2018 Status: Enacted
RELATING TO PHARMACY BENEFIT MANAGERS AND INFORMATION ON PRESCRIPTION DRUGS: Authorizing the Maryland Insurance Commissioner to require any additional information from a pharmacy benefits manager that may be reasonably necessary to verify information in a …
HB 1420 (see companion bill SB 875) – Maryland
Introduced: 2020 Status: Enacted
Hospitals – Financial Assistance Policies and Bill Collections. Increasing the family income threshold at which a hospital’s financial assistance policy must provide free and reduced cost medically necessary care to patients; requiring that a certain …
HB 1571 (see companion bill SB 938) – Maryland
Introduced: 2020 Status: Enacted
Hospitals – Changes in Status – Hospital Employee Retraining and Placement. Providing that the assessment of a certain fee by the State Health Services Cost Review Commission for funding the Hospital Employees Retraining Fund is …
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
LEGISLATION/REGULATION
Legislative Calendar
Maryland has a yearly legislative term. The most recent term was adjourned on March 18, 2020. The next term will begin in 2021.
STATE BUDGET
Maryland’s fiscal year begins on July 1 and ends on June 30 of the following year. Maryland enacted its FY 2020 Budget during the 2019 regular legislative session. The administration continues to invest funds into critical health care services and related programs, such as investing over $11.5 billion into the Maryland Medicaid program. View Maryland’s FY 2020 Budget here.
REGULATION & ENFORCEMENT
Maryland was one of 16 states to file an amicus brief supporting the FTC’s winning position in the Ninth Circuit appeal of St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), decided February 10, 2015. The States’ brief stated that the acceleration of health care costs due to the growth of large health care provider systems had become a matter of grave concern for the states.
KEY RESOURCES