Maryland Medical Assistance Program, Maryland Children's Health Program, and Health Insurance - Transfers to Special Pediatric Hospitals - Requirements

Summary

The law requires the state Medicaid program, the Maryland Children’s Health Program, managed‑care organizations, insurers and health plans to issue a prior‑authorization determination within three business days when a special pediatric hospital or referring provider requests a transfer. If the determination is contested, the hospital or provider can request a retrospective review, and they will be reimbursed for administrative days during the review. The Department of Health must adopt regulations for the review process by Dec. 31 2026, and the rules apply to policies issued on or after Jan. 1 2027.

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