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WES MOORE, Governor Ch. 650
Chapter 650
(Senate Bill 521)
AN ACT concerning
Health Insurance – Material Changes to Provider Networks – Notification and
Special Enrollment Period
FOR the purpose of requiring certain health systems to comply with certain insurance
provisions regarding notice of termination of contracts; altering the notification
requirements a carrier is required to provide an enrollee regarding changes to the
carrier’s provider panel; altering the notice requirements a carrier is required to
provide to the Insurance Commissioner for certain material changes to the carrier’s
provider panel; requiring certain notice if a carrier and health system intend to
terminate certain contracts; requiring certain carriers and health systems to adhere
to the terms of certain contracts under certain circumstances; requiring certain
carriers to provide certain special enrollment periods for individuals who are
patients of certain providers that are terminated from certain provider panels; and
generally relating to material changes to carrier provider networks.
BY adding to
Article – Health – General
Section 19–310.7
Annotated Code of Maryland
(2023 Replacement Volume and 2025 Supplement)
BY repealing and reenacting, with amendments,
Article – Insurance
Section 15–112(b)(1)(ii)2. and, (c)(2), and (m) and 15–1316(a), (c), (d), (e), and (f)
Annotated Code of Maryland
(2017 Replacement Volume and 2025 Supplement)
BY adding to
Article – Insurance
Section 15–112(b)(4) and (y)
Annotated Code of Maryland
(2017 Replacement Volume and 2025 Supplement)
BY repealing and reenacting, without amendments,
Article – Insurance
Section 15–112(c)(1)
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:
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Ch. 650 2026 LAWS OF MARYLAND
Article – Health – General
19–310.7.
(A) IN THIS SECTION, “HEALTH SYSTEM” HAS THE MEANING STATED IN §
15–112(Y) OF THE INSURANCE ARTICLE.
(B) A HEALTH SYSTEM SHALL COMPLY WITH § 15–112(Y) OF THE
INSURANCE ARTICLE.
Article – Insurance
15–112.
(b) (1) Subject to paragraph (3) of this subsection, a carrier that uses a
provider panel shall:
(ii) establish procedures to:
2. notify an enrollee of:
A. the termination from the carrier’s provider panel,
INCLUDING WHEN THE PROVIDER ELECTS TO TERMINATE PARTICIPATION FROM
THE PROVIDER PANEL, of the primary care provider that was furnishing health care
services to the enrollee AND ANY PROVIDER OF BEHAVIORAL HEALTH CARE SERVICES
FOR WHOM THE CARRIER HAS RECEIVED A CLAIM FOR SERVICES PERFORMED ON
THE ENROLLEE WITHIN THE 3 MONTHS IMMEDIATELY PRECEDING THE DATE OF THE
TERMINATION; and
B. the right of the enrollee, on request, to continue to receive
health care services from the [enrollee’s primary care provider] PROVIDERS DESCRIBED
IN ITEM A OF THIS ITEM for up to 90 days after the date of the notice of termination of the
[enrollee’s primary care] provider from the carrier’s provider panel, if the termination was
for reasons unrelated to fraud, patient abuse, incompetency, or loss of licensure status;
(4) THE NOTICE REQUIRED UNDER PARAGRAPH (1)(II)2 OF THIS
SUBSECTION SHALL INCLUDE:
(I) CONTACT INFORMATION THAT THE ENROLLEE MAY USE TO
DIRECT COMMENTS OR CONCERNS TO THE CARRIER REGARDING THE TERMINATION
OF THE PROVIDER FROM THE CARRIER’S PROVIDER PANEL;
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WES MOORE, Governor Ch. 650
(II) INSTRUCTIONS ON HOW THE ENROLLEE MAY NOTIFY THE
CARRIER OF THE NEED FOR TRANSITIONAL CARE AS DESCRIBED IN PARAGRAPH
(1)(II)2B OF THIS SUBSECTION BY SUBMITTING A UNIFORM FORM DEVELOPED BY
THE COMMISSIONER UNDER SUBSECTION (Y)(4) OF THIS SECTION; AND
(III) THE TELEPHONE NUMBER AND E–MAIL ADDRESS FOR THE
OFFICE IN THE ADMINISTRATION THAT IS RESPONSIBLE FOR RECEIVING AND
RESPONDING TO COMPLAINTS FROM ENROLLEES ABOUT CARRIERS.
(c) (1) This subsection applies to a carrier that:
(i) is an insurer, a nonprofit health service plan, or a health
maintenance organization; and
(ii) uses a provider panel for a health benefit plan offered by the
carrier.
(2) (i) On or before July 1, 2018, and annually thereafter, a carrier shall
file with the Commissioner for review by the Commissioner an access plan that meets the
requirements of subsection (b) of this section and any regulations adopted by the
Commissioner under subsections (b) and (d) of this section.
(ii) If the [carrier makes] TERMINATION OF A PROVIDER OR
HEALTH CARE FACILITY FROM THE CARRIER’S PROVIDER PANEL WILL RESULT IN a
material change to the access plan, the carrier shall:
1. SUBJECT TO SUBPARAGRAPH (IV) OF THIS
PARAGRAPH, notify the Commissioner of the [change within 15 business days after the
change occurs] IMPENDING TERMINATION AT LEAST 60 DAYS BEFORE THE
ANTICIPATED DATE OF TERMINATION; [and]
2. HAVE A CONTINUING OBLIGATION TO UPDATE AND
SUPPLEMENT THE INITIAL AND SUBSEQUENT NOTIFICATIONS UNTIL THE
TERMINATION IS EFFECTIVE OR AN AGREEMENT IS REACHED WITH THE PROVIDER
OR HEALTH CARE FACILITY; AND
[2.] 3. [include in the notice required under item 1 of this
subparagraph a reasonable timeframe within which the carrier will] SUBJECT TO
SUBPARAGRAPH (V) OF THIS PARAGRAPH, WITHIN 5 BUSINESS DAYS AFTER THE
EFFECTIVE DATE OF THE TERMINATION, file with the Commissioner an update to the
existing access plan for review by the Commissioner.
(iii) The Commissioner may order corrective action if, after review,
the access plan is determined not to meet the requirements of this subsection.
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Ch. 650 2026 LAWS OF MARYLAND
(IV) THE NOTICE REQUIRED UNDER SUBPARAGRAPH (II)1 OF
THIS PARAGRAPH SHALL BE PROVIDED IF:
1. THE PROVIDER OR HEALTH CARE FACILITY PROVIDES
ADVANCE NOTICE TO THE CARRIER OF ITS INTENTION TO TERMINATE
PARTICIPATION IN THE CARRIER’S PROVIDER PANEL;
2. THE CARRIER PROVIDES ADVANCE NOTICE TO THE
PROVIDER OR HEALTH CARE FACILITY OF THE CARRIER’S INTENTION TO
TERMINATE THE PROVIDER OR HEALTH CARE FACILITY FROM THE CARRIER’S
PROVIDER PANEL;
3. THE CURRENT TERM OF THE EXISTING NETWORK
PARTICIPATION CONTRACT BETWEEN THE CARRIER AND THE PROVIDER OR HEALTH
CARE FACILITY IS SET TO EXPIRE WITHIN 60 DAYS AND AN AGREEMENT TO EXTEND
OR RENEW THE CONTRACT HAS NOT BEEN REACHED; OR
4. THE CARRIER POSSESSES OTHER INFORMATION THAT
IT REASONABLY DETERMINES IS AN INDICATION THAT TERMINATION OF THE
PROVIDER OR HEALTH CARE FACILITY FROM THE CARRIER’S PROVIDER PANEL IS
LIKELY IN THE NEXT 60 DAYS.
(V) THE UPDATE TO THE EXISTING ACCESS PLAN REQUIRED TO
BE FILED UNDER SUBPARAGRAPH (II)3 OF THIS PARAGRAPH IS REQUIRED TO
INCLUDE ONLY INFORMATION RELATED TO:
1. THE PROVIDER SPECIALTY TYPES AFFECTED BY THE
MATERIAL CHANGE; AND
2. UNLESS THE NETWORK AS A WHOLE EXPERIENCED A
10% REDUCTION, THE GEOGRAPHIC AREAS WHERE ENROLLEES WERE AFFECTED BY
THE MATERIAL CHANGE.
(VI) THE COMMISSIONER MAY IMPOSE A FINE OF $5,000 PER
DAY FOR EACH DAY PAST 5 BUSINESS DAYS THAT THE CARRIER FAILS TO FILE AN
UPDATE TO THE EXISTING ACCESS PLAN AS REQUIRED BY SUBPARAGRAPH (II)3 OF
THIS PARAGRAPH.
(m) (1) For at least 90 days after the date of the notice of termination of a
primary care provider OR A PROVIDER OF BEHAVIORAL HEALTH CARE SERVICES from
a carrier’s provider panel for reasons unrelated to fraud, patient abuse, incompetency, or
loss of licensure status, the [primary care] provider shall furnish health care services to
each enrollee:
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WES MOORE, Governor Ch. 650
(i) who was receiving health care services from the [primary care]
provider before the notice of termination; and
(ii) who, after receiving notice under subsection (b) of this section of
the termination of the [primary care] provider, requests to continue receiving health care
services from the [primary care] provider.
(2) A carrier shall reimburse a [primary care] provider that furnishes
health care services under this subsection in accordance with the [primary care] provider’s
agreement with the carrier.
(3) A PROVIDER THAT FURNISHES HEALTH CARE SERVICES UNDER
THIS SUBSECTION IN ACCORDANCE WITH A PROVIDER’S AGREEMENT WITH A
CARRIER SHALL ACCEPT AS PAYMENT IN FULL FOR THE SERVICES PAYMENT FROM
THE CARRIER AND COST–SHARING FROM THE PATIENT, AS APPLICABLE.
(Y) (1) IN THIS SUBSECTION, “HEALTH SYSTEM” MEANS:
(I) A HOSPITAL AND ANY ENTITY AFFILIATED WITH THE
HOSPITAL THROUGH OWNERSHIP, GOVERNANCE, MEMBERSHIP, OR OTHER MEANS;
OR
(II) A PARENT CORPORATION OF ONE OR MORE HOSPITALS AND
ANY ENTITY AFFILIATED WITH THE PARENT CORPORATION THROUGH OWNERSHIP,
GOVERNANCE, MEMBERSHIP, OR OTHER MEANS.
(2) (I) A CARRIER AND A HEALTH SYSTEM SHALL PROVIDE TO
EACH OTHER WRITTEN NOTICE OF ANY INTENT TO TERMINATE A CONTRACT
BETWEEN THE CARRIER AND THE HEALTH SYSTEM:
1. (I) AT LEAST 90 DAYS BEFORE THE PROPOSED DATE OF
TERMINATION OF THE CONTRACT; OR
2. (II) IN THE CASE OF A NONRENEWAL, AT LEAST 90 DAYS
BEFORE THE END OF THE CONTRACT PERIOD.
(II) A CARRIER SHALL MAKE A GOOD FAITH EFFORT TO
PROVIDE WRITTEN NOTICE OF A TERMINATION AS REQUIRED UNDER
SUBPARAGRAPH (I) OF THIS PARAGRAPH TO ALL COVERED INDIVIDUALS WHO ARE
PATIENTS BEING TREATED ON A REGULAR BASIS BY OR AT THE HEALTH SYSTEM:
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Ch. 650 2026 LAWS OF MARYLAND
1. AT LEAST 30 DAYS BEFORE THE PROPOSED DATE OF
TERMINATION OF THE CONTRACT; OR
2. IN THE CASE OF A NONRENEWAL, AT LEAST 30 DAYS
BEFORE THE END OF THE CONTRACT PERIOD.
(3) (I) FOR EACH CONTRACT BETWEEN A CARRIER AND A HEALTH
SYSTEM THAT IS ENTERED INTO, RENEWED, AMENDED, OR CONTINUED ON OR AFTER
OCTOBER 1, 2026, IF THE CONTRACT IS NOT RENEWED OR IS TERMINATED BY THE
CARRIER OR THE HEALTH SYSTEM, THE CARRIER AND THE HEALTH SYSTEM SHALL
CONTINUE TO ADHERE TO THE TERMS OF THE CONTRACT, INCLUDING
REIMBURSEMENT TERMS AND PATIENT BALANCE BILLING PROTECTIONS FOR ALL
HEALTH CARE SERVICES PROVIDED UNDER THE CONTRACT, FOR A PERIOD OF:
1. AT LEAST 90 DAYS AFTER THE DATE OF TERMINATION;
OR
2. IN THE CASE OF A NONRENEWAL, AT LEAST 90 DAYS
AFTER THE END OF THE CONTRACT PERIOD.
(II) EXCEPT AS OTHERWISE AGREED TO BY A CARRIER AND A
HEALTH SYSTEM, THE REIMBURSEMENT TERMS OF A CONTRACT ENTERED INTO BY
THE CARRIER AND THE HEALTH SYSTEM DURING THE 90–DAY PERIOD SHALL BE
RETROACTIVE TO:
1. THE DATE OF TERMINATION; OR
2. IN THE CASE OF A NONRENEWAL, THE END DATE OF
THE CONTRACT PERIOD.
(III) THIS PARAGRAPH DOES NOT APPLY IF THE CARRIER AND
HEALTH SYSTEM:
1. AGREE, IN WRITING, TO THE TERMINATION OR
NONRENEWAL OF THE CONTRACT; AND
2. PROVIDE THE NOTICES REQUIRED UNDER
PARAGRAPH (1) (2) OF THIS SUBSECTION.
(4) THE COMMISSIONER SHALL DEVELOP A UNIFORM FORM THAT
CARRIERS, PROVIDERS, AND HEALTH SYSTEMS SHALL USE FOR REQUESTS TO
CONTINUE TO RECEIVE HEALTH CARE SERVICES IN ACCORDANCE WITH SUBSECTION
(B) OF THIS SECTION OR 42 U.S.C. § 300GG–113.
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WES MOORE, Governor Ch. 650
15–1316.
(a) (1) In this section the following words have the meanings indicated.
(2) “Dependent” means an individual who is or who may become eligible
for coverage under the terms of a health benefit plan because of a relationship with another
individual.
(3) “Health care practitioner” has the meaning stated in § 1–301 of the
Health Occupations Article.
(4) “PROVIDER” MEANS A HEALTH CARE PRACTITIONER OR A
HEALTH CARE FACILITY THAT PARTICIPATES ON A HEALTH BENEFIT PLAN’S
PROVIDER PANEL.
[(4)] (5) “Qualifying coverage in an eligible employer–sponsored plan”
has the meaning stated in 45 C.F.R. § 155.300.
(c) A carrier participating in the Individual Exchange shall provide:
(1) the special enrollment periods specified in 45 C.F.R. § 155.420 for
individuals who purchase coverage through the Individual Exchange; [and]
(2) a special enrollment period for an individual who purchases coverage
through the Individual Exchange if the individual or a dependent of the individual becomes
pregnant, as confirmed by a health care practitioner; AND
(3) A SPECIAL ENROLLMENT PERIOD FOR AN INDIVIDUAL WHO
PURCHASES COVERAGE THROUGH THE INDIVIDUAL EXCHANGE IF THE INDIVIDUAL
OR A DEPENDENT OF THE INDIVIDUAL IS:
(I) A PATIENT BEING TREATED ON A REGULAR BASIS BY OR AT
A PROVIDER; AND
(II) ENROLLED IN A HEALTH BENEFIT PLAN IN WHICH THE
PROVIDER TREATING THE INDIVIDUAL OR DEPENDENT IS TERMINATED FROM THE
HEALTH BENEFIT PLAN’S PROVIDER PANEL.
(d) A carrier shall provide:
(1) the special enrollment periods specified in 45 C.F.R. § 147.104(b)(2) for
individuals who purchase coverage outside the Individual Exchange; [and]
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Ch. 650 2026 LAWS OF MARYLAND
(2) a special enrollment period for an individual who purchases coverage
outside the Individual Exchange if the individual or a dependent of the individual becomes
pregnant, as confirmed by a health care practitioner; AND
(3) A SPECIAL ENROLLMENT PERIOD FOR AN INDIVIDUAL WHO
PURCHASES COVERAGE OUTSIDE THE INDIVIDUAL EXCHANGE IF THE INDIVIDUAL
OR A DEPENDENT OF THE INDIVIDUAL IS:
(I) A PATIENT BEING TREATED ON A REGULAR BASIS BY OR AT
A PROVIDER; AND
(II) ENROLLED IN A HEALTH BENEFIT PLAN IN WHICH THE
PROVIDER TREATING THE INDIVIDUAL OR DEPENDENT IS TERMINATED FROM THE
HEALTH BENEFIT PLAN’S PROVIDER PANEL.
(e) (1) A special enrollment period described in subsection (c)(2) or (d)(2) of this
section shall:
[(1)] (I) be open for a period of 90 days; and
[(2)] (II) begin on the date the health care practitioner confirms the
pregnancy.
(2) A SPECIAL ENROLLMENT PERIOD DESCRIBED IN SUBSECTION
(C)(3) OR (D)(3) OF THIS SECTION SHALL:
(I) BE OPEN FOR A PERIOD OF 90 DAYS; AND
(II) BEGIN ON:
1. THE DATE OF TERMINATION OF THE PROVIDER FROM
THE HEALTH BENEFIT PLAN’S PROVIDER PANEL; OR
2. IF THE CONSUMER DID NOT RECEIVE NOTICE OF THE
TERMINATION BEFORE THE TERMINATION DATE, THE DATE OF THE NOTICE OF
TERMINATION.
(f) (1) If an individual enrolls for coverage during one of the open enrollment
periods described in subsection (b) of this section or during one of the special open
enrollment periods described in subsections (c)(1) and (d)(1) of this section, coverage shall
be effective in accordance with the requirements in 45 C.F.R. § 155.420.
(2) If an individual enrolls for coverage or enrolls a dependent for coverage
during a special enrollment period described in subsection (c)(2) or (d)(2) of this section, the
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WES MOORE, Governor Ch. 650
coverage shall become effective on the first day of the month in which the individual
receives confirmation of pregnancy.
(3) IF AN INDIVIDUAL ENROLLS FOR COVERAGE OR ENROLLS A
DEPENDENT FOR COVERAGE DURING A SPECIAL ENROLLMENT PERIOD DESCRIBED
IN SUBSECTION (C)(3) OR (D)(3) OF THIS SECTION, THE INDIVIDUAL SHALL SELECT
IF COVERAGE SHALL BECOME EFFECTIVE:
(I) ON THE FIRST DAY OF THE MONTH FOLLOWING THE DATE
THE HEALTH BENEFIT PLAN WAS SELECTED; OR
(II) ON THE FIRST DAY OF THE MONTH IN WHICH THE
TERMINATION OF THE PROVIDER ON THE HEALTH BENEFIT PLAN’S PROVIDER
PANEL BECAME EFFECTIVE.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2026.
Approved by the Governor, May 26, 2026.
–9–Every fact on this page links to its source, starting with the official bill record.