Shown verbatim: the complete text as captured from the official PDF posted by the Maryland General Assembly, fetched 2026-09-25. Page and line markers are part of the official record; nothing is edited or removed. This is the chaptered version. The official bill page.
WES MOORE, Governor Ch. 628
Chapter 628
(House Bill 445)
AN ACT concerning
Maryland Medical Assistance Program and Health Insurance – Coverage for
Orthoses and Prostheses
(So Every Body Can Move Act)
FOR the purpose of requiring the Maryland Medical Assistance Program and certain
insurers, nonprofit health service plans, and health maintenance organizations to
provide certain coverage related to orthoses; establishing that certain insurers,
nonprofit health service plans, and health maintenance organizations must comply
with certain provider network requirements; clarifying that certain mandated
benefits related to prostheses include all prostheses determined by a treating health
care provider to be medically necessary for certain purposes; and generally relating
to coverage and reimbursement for orthoses and prostheses.
BY repealing and reenacting, without amendments,
Article – Health – General
Section 15–103(a)(1)
Annotated Code of Maryland
(2023 Replacement Volume and 2025 Supplement)
BY repealing and reenacting, with amendments,
Article – Health – General
Section 15–103(a)(2)(xxvii) and (xxviii)
Annotated Code of Maryland
(2023 Replacement Volume and 2025 Supplement)
BY adding to
Article – Health – General
Section 15–103(a)(2)(xxix)
Annotated Code of Maryland
(2023 Replacement Volume and 2025 Supplement)
BY repealing and reenacting, with amendments,
Article – Insurance
Section 15–820 and 15–844(g)
Annotated Code of Maryland
(2017 Replacement Volume and 2025 Supplement)
BY repealing and reenacting, without amendments,
Article – Insurance
Section 15–844(a) through (c)
Annotated Code of Maryland
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Ch. 628 2026 LAWS OF MARYLAND
(2017 Replacement Volume and 2025 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health – General
15–103.
(a) (1) The Secretary shall administer the Maryland Medical Assistance
Program.
(2) The Program:
(xxvii)Beginning on January 1, 2026, if providing coverage for the
delivery of anesthesia, shall provide coverage for the delivery of anesthesia in accordance
with § 15–862 of the Insurance Article; [and]
(xxviii) Beginning on January 1, 2026, shall provide calcium score
testing in accordance with § 15–863 of the Insurance Article; AND
(XXIX) BEGINNING ON JANUARY 1, 2027, SHALL PROVIDE
COVERAGE FOR ORTHOSES IN ACCORDANCE WITH § 15–820 OF THE INSURANCE
ARTICLE.
Article – Insurance
15–820.
(a) (1) In this section, [“orthopedic brace”] “ORTHOSIS” means a rigid or
semi–rigid device that is used to:
[(1)] (I) support a weak or [deformed] MISALIGNED body member; or
[(2)] (II) restrict or eliminate motion [in a diseased or injured part of the
body], IMPROVE FUNCTION, OR RELIEVE SYMPTOMS OF A DISEASE, AN INJURY, OR A
POST–OPERATIVE CONDITION IN A PART OF THE BODY.
(2) “ORTHOSIS” INCLUDES A CUSTOM–DESIGNED,
CUSTOM–FABRICATED, CUSTOM–MOLDED, CUSTOM–FITTED, OR MODIFIED DEVICE
TO TREAT A NEUROMUSCULAR OR, MUSCULOSKELETAL DISORDER OR, ACQUIRED,
OR CONGENITAL CONDITION.
(B) THIS SECTION APPLIES TO:
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WES MOORE, Governor Ch. 628
(1) INSURERS AND NONPROFIT HEALTH SERVICE PLANS THAT
PROVIDE HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS
ON AN EXPENSE–INCURRED BASIS UNDER HEALTH INSURANCE POLICIES OR
CONTRACTS THAT ARE ISSUED OR DELIVERED IN THE STATE; AND
(2) HEALTH MAINTENANCE ORGANIZATIONS THAT PROVIDE
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS UNDER
CONTRACTS THAT ARE ISSUED OR DELIVERED IN THE STATE.
[(b)] (C) [Each health insurance contract that is delivered or issued for delivery
in the State by a nonprofit health service plan and that provides hospital benefits] AN
ENTITY SUBJECT TO THIS SECTION shall provide [benefits for orthopedic braces] ONCE
ANNUALLY COVERAGE FOR:
(1) ORTHOSES;
(2) COMPONENTS OF ORTHOSES;
(3) REPAIRS TO ORTHOSES; AND
(4) SUBJECT TO SUBSECTION (D) OF THIS SECTION, REPLACEMENTS
OF ORTHOSES OR ORTHOSIS COMPONENTS.
(D) (1) AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE
COVERAGE FOR REPLACEMENTS OF ORTHOSES WITHOUT REGARD TO CONTINUOUS
USE OR USEFUL LIFETIME RESTRICTIONS IF AN ORDERING HEALTH CARE PROVIDER
DETERMINES THAT THE PROVISION OF A REPLACEMENT ORTHOSIS OR A
REPLACEMENT COMPONENT OF THE ORTHOSIS IS NECESSARY:
(I) BECAUSE OF A CHANGE IN THE PHYSIOLOGICAL CONDITION
OF THE PATIENT; OR
(II) UNLESS NECESSITATED BY MISUSE, BECAUSE OF AN
IRREPARABLE CHANGE IN THE CONDITION OF THE ORTHOSIS OR A COMPONENT OF
THE ORTHOSIS.
(2) AN ENTITY SUBJECT TO THIS SECTION MAY REQUIRE AN
ORDERING HEALTH CARE PROVIDER TO CONFIRM THAT THE ORTHOSIS OR
COMPONENT OF THE ORTHOSIS BEING REPLACED MEETS THE REQUIREMENTS OF
PARAGRAPH (1) OF THIS SUBSECTION IF THE ORTHOSIS OR COMPONENT OF THE
ORTHOSIS IS LESS THAN 1 YEAR OLD.
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Ch. 628 2026 LAWS OF MARYLAND
(E) THE COVERED BENEFITS UNDER THIS SECTION MAY NOT BE SUBJECT
TO A HIGHER COPAYMENT OR COINSURANCE REQUIREMENT THAN THE COPAYMENT
OR COINSURANCE FOR OTHER SIMILAR MEDICAL AND SURGICAL BENEFITS
COVERED UNDER THE POLICY OR CONTRACT OF THE INSURED OR ENROLLEE.
(F) AN ENTITY SUBJECT TO THIS SECTION MAY NOT IMPOSE AN ANNUAL OR
LIFETIME DOLLAR MAXIMUM ON COVERAGE REQUIRED UNDER THIS SECTION
SEPARATE FROM ANY ANNUAL OR LIFETIME DOLLAR MAXIMUM THAT APPLIES IN
THE AGGREGATE TO ALL COVERED BENEFITS UNDER THE POLICY OR CONTRACT OF
THE INSURED OR ENROLLEE.
(G) (1) AN ENTITY SUBJECT TO THIS SECTION MAY NOT ESTABLISH
REQUIREMENTS FOR MEDICAL NECESSITY OR APPROPRIATENESS FOR THE
COVERAGE REQUIRED UNDER THIS SECTION THAT ARE MORE RESTRICTIVE THAN
THE INDICATIONS AND LIMITATIONS OF COVERAGE AND MEDICAL NECESSITY
ESTABLISHED UNDER THE MEDICARE COVERAGE DATABASE.
(2) THE COVERED BENEFITS UNDER THIS SECTION INCLUDE ALL
ORTHOSES DETERMINED BY A TREATING HEALTH CARE PROVIDER TO BE
MEDICALLY NECESSARY FOR:
(I) COMPLETING ACTIVITIES OF DAILY LIVING;
(II) ESSENTIAL JOB–RELATED ACTIVITIES; OR
(III) PERFORMING PHYSICAL ACTIVITIES INCLUDING RUNNING,
BIKING, SWIMMING, STRENGTH TRAINING, AND OTHER ACTIVITIES TO MAXIMIZE
THE WHOLE–BODY HEALTH AND LOWER OR UPPER LIMB FUNCTION OF THE INSURED
OR ENROLLEE.
(H) AN ENTITY SUBJECT TO THIS SECTION THAT USES A PROVIDER PANEL
FOR A POLICY OR CONTRACT DESCRIBED IN SUBSECTION (B) OF THIS SECTION AND
THE PROVISION OF COVERED BENEFITS UNDER THIS SECTION SHALL COMPLY WITH
§ 15–112(B)(3) OF THIS TITLE.
15–844.
(a) (1) In this section, “prosthesis” means an artificial device to replace, in
whole or in part, a leg, an arm, or an eye.
(2) “Prosthesis” includes a custom–designed, –fabricated, –fitted, or
–modified device to treat partial or total limb loss for purposes of restoring physiological
function.
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WES MOORE, Governor Ch. 628
(b) This section applies to:
(1) insurers and nonprofit health service plans that provide hospital,
medical, or surgical benefits to individuals or groups on an expense–incurred basis under
health insurance policies or contracts that are issued or delivered in the State; and
(2) health maintenance organizations that provide hospital, medical, or
surgical benefits to individuals or groups under contracts that are issued or delivered in
the State.
(c) An entity subject to this section shall provide once annually coverage for:
(1) prostheses;
(2) components of prostheses;
(3) repairs to prostheses; and
(4) subject to subsection (d) of this section, replacements of prostheses or
prosthesis components.
(g) (1) An entity subject to this section may not establish requirements for
medical necessity or appropriateness for the coverage required under this section that are
more restrictive than the indications and limitations of coverage and medical necessity
established under the Medicare Coverage Database.
(2) The covered benefits under this section include ALL prostheses
determined by a treating health care provider to be medically necessary for:
(i) completing activities of daily living;
(ii) essential job–related activities; or
(iii) performing physical activities, including running, biking,
swimming, strength training, and other activities to maximize the whole–body health and
lower or upper limb function of the insured or enrollee.
SECTION 2. AND BE IT FURTHER ENACTED, That it is the intent of the General
Assembly that Section 1 of this Act may not be construed to require managed care
organizations under the Maryland Medical Assistance Program to cover additional
Healthcare Common Procedure Coding System (HCPCS) “L” codes for orthotic procedures
and devices than are covered by managed care organizations as of December 31, 2026.
SECTION 3. AND BE IT FURTHER ENACTED, That:
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Ch. 628 2026 LAWS OF MARYLAND
(a) On or before June 30, 2032, each entity that is subject to § 15–820 of the
Insurance Article, as enacted by Section 1 of this Act, and each managed care organization
providing coverage under the Maryland Medical Assistance Program shall report to the
Maryland Insurance Administration and the Maryland Department of Health, respectively,
on its compliance with § 15–820 of the Insurance Article or § 15–103(a)(2)(xxix) of the
Health – General Article, as enacted by Section 1 of this Act, and, as applicable, for calendar
years 2027 through 2030.
(b) (1) The Maryland Insurance Administration and the Maryland
Department of Health shall jointly prescribe the form for the report required under
subsection (a) of this section.
(2) The form must include the number of claims and the total amount of
claims paid in the State for the coverage required by § 15–820 of the Insurance Article or §
15–103(a)(2)(xxix) of the Health – General Article, as enacted by Section 1 of this Act, and
as applicable.
(c) (1) The Maryland Insurance Administration and the Maryland
Department of Health shall aggregate the data required under subsection (b) of this section
in a joint report by calendar year.
(2) On or before December 31, 2032, the Maryland Insurance
Administration and the Maryland Department of Health shall submit the joint report to
the Senate Finance Committee and the House Health and Government Operations
Committee, in accordance with § 2–1257 of the State Government Article.
SECTION 4. AND BE IT FURTHER ENACTED, That Section 1 of this Act shall
apply to all policies, contracts, and health benefit plans issued, delivered, or renewed in the
State on or after January 1, 2027.
SECTION 5. AND BE IT FURTHER ENACTED, That this Act shall take effect
January 1, 2027.
Approved by the Governor, May 26, 2026.
–6–Every fact on this page links to its source, starting with the official bill record.