Maryland Medical Assistance Program and Health Insurance - Collaborative Care Model - Cost Sharing Prohibition, the official text

WES MOORE, Governor                  Ch. 614

Chapter 614

                   (Senate Bill 428)

AN ACT concerning

Maryland Medical Assistance Program and Health Insurance – Collaborative
                             Care Model – Cost Sharing Prohibition

FOR the purpose of prohibiting the Maryland Department of Health and certain insurers,
         nonprofit health plans, and health maintenance organizations from imposing a
         copay, coinsurance, or deductible for services provided in accordance with the
         Collaborative Care Model; requiring certain insurers, nonprofit health plans, and
         health maintenance organizations to provide coverage for services provided in
         accordance with the Collaborative Care Model; requiring the Maryland Health Care
         Commission to study the impact of eliminating health insurance cost–sharing for
         services provided under the Collaborative Care Model by certain insurers, nonprofit
         health plans, and health maintenance organizations; and generally relating to cost
         sharing and the Collaborative Care Model.

BY repealing and reenacting, with amendments,
         Article – Health – General
         Section 15–141.1
         Annotated Code of Maryland
         (2023 Replacement Volume and 2025 Supplement)

BY adding to
         Article – Insurance
         Section 15–864
         Annotated Code 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

15–141.1.

         (a) In this section, “Collaborative Care Model” means an evidence–based
approach for integrating somatic and behavioral health services in primary care settings
that includes:

             (1) Care coordination and management;

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Ch. 614  2026 LAWS OF MARYLAND

                  (2) Regular, proactive outcome monitoring and treatment for outcome
targets using standardized outcome measurement rating scales and electronic tools, such
as patient tracking; and

                  (3) Regular systematic psychiatric and substance use disorder caseload
reviews and consultation with a psychiatrist, an addiction medicine specialist, or any other
behavioral health medicine specialist as allowed under federal regulations governing the
model.

         (b) This section may not be construed to prohibit referrals from a primary care
provider to a specialty behavioral health care provider.

         (c) The Department shall implement and provide reimbursement for services
provided in accordance with the Collaborative Care Model statewide in primary care
settings that provide health care services to Program recipients.

        (D) THE DEPARTMENT MAY NOT IMPOSE A COPAYMENT, COINSURANCE, OR

DEDUCTIBLE REQUIREMENT FOR SERVICES PROVIDED IN ACCORDANCE WITH THE

COLLABORATIVE CARE MODEL STATEWIDE IN PRIMARY CARE SETTINGS THAT
PROVIDE HEALTH CARE SERVICES TO PROGRAM RECIPIENTS.

         SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read
as follows:

                                                Article – Insurance

15–864.

        (A) IN THIS SECTION, “COLLABORATIVE CARE MODEL” HAS THE MEANING
STATED IN § 15–141.1 OF THE HEALTH – GENERAL ARTICLE.

        (B) THIS SECTION APPLIES TO:

                (1) INSURERS AND NONPROFIT HEALTH SERVICE PLANS THAT

PROVIDE COVERAGE FOR SERVICES PROVIDED IN ACCORDANCE WITH THE

COLLABORATIVE CARE MODEL UNDER INDIVIDUAL, GROUP, OR BLANKET
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
COVERAGE FOR SERVICES PROVIDED IN ACCORDANCE WITH THE COLLABORATIVE
CARE MODEL UNDER INDIVIDUAL OR GROUP HOSPITAL, MEDICAL, OR SURGICAL

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WES MOORE, Governor  Ch. 614

BENEFITS TO INDIVIDUALS OR GROUPS UNDER CONTRACTS THAT ARE ISSUED OR

DELIVERED IN THE STATE.

        (C) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS SUBSECTION,
AN ENTITY SUBJECT TO THIS SECTION MAY NOT IMPOSE A COPAYMENT,
COINSURANCE, OR DEDUCTIBLE REQUIREMENT ON COVERAGE FOR SERVICES
PROVIDED IN ACCORDANCE WITH THE COLLABORATIVE CARE MODEL.

                (2) IF AN INSURED OR ENROLLEE IS COVERED UNDER A
HIGH–DEDUCTIBLE HEALTH PLAN, AS DEFINED IN 26 U.S.C. § 223, AN ENTITY

SUBJECT TO THIS SECTION MAY SUBJECT SERVICES PROVIDED IN ACCORDANCE

WITH THE COLLABORATIVE CARE MODEL TO THE DEDUCTIBLE REQUIREMENT OF
THE HIGH–DEDUCTIBLE HEALTH PLAN.

        (C) AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE COVERAGE FOR
SERVICES PROVIDED IN ACCORDANCE WITH THE COLLABORATIVE CARE MODEL.

         SECTION 3. AND BE IT FURTHER ENACTED, That on or before December 1, 2026,
the Maryland Health Care Commission shall:

                  (1) conduct a study in accordance with § 15–1501 of the Insurance Article
on the impact of eliminating health insurance cost–sharing for services provided under the
Collaborative Care Model by insurers, nonprofit health service plans, and health
maintenance organizations that provide coverage for services provided in accordance with
the Collaborative Care Model under individual, group, or blanket health insurance policies
or contracts that are issued or delivered in the State; and

                  (2) report its findings and recommendations, in accordance with § 2–1257
of the State Government Article, to the Senate Finance Committee and the House Health
Committee.

         SECTION 3. 4. AND BE IT FURTHER ENACTED, That Section 2 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 4. 5. AND BE IT FURTHER ENACTED, That Sections 2 and 3 4 of this
Act shall take effect January 1, 2027.

         SECTION 5. 6. AND BE IT FURTHER ENACTED, That, except as provided in
Section 4 5 of this Act, this Act shall take effect July 1, 2026.

Approved by the Governor, May 26, 2026.

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