§ 15–158
Statutes in effect as of October 1, 2026.
Md. Code Ann., Health-Gen. § 15-158 (2026)
Title 15. Assistance Programs
Subtitle 1. Medical and Pharmacy Assistance Programs
§ 15–158LinkCopy Citation
(a)
(1)
Subject to paragraph (2) of this subsection, the Program may not require prior authorization for a transfer to a special pediatric hospital.
(2)
At the request of a special pediatric hospital, the Program and the Maryland Children’s Health Program shall provide a prior authorization determination regarding a transfer to a special pediatric hospital within 3 business days after the request is received.
(b)
(1)
On or before December 31, 2026, the Department shall adopt regulations establishing a retrospective review process for special pediatric hospitals.
(2)
The regulations adopted under paragraph (1) of this subsection shall:
(i)
Provide for a peer–to–peer reconsideration of a medical necessity determination made by the Department or its agent on request of a pediatric specialty hospital;
(ii)
Provide for retrospective review of any medical necessity determination issued by the Department or its agent denying:
(1)
Admission to a special pediatric hospital on or after January 1, 2025; or
(2)
Reimbursement for inpatient services or outpatient services provided by a special pediatric hospital on or after January 1, 2025;
(iii)
Comply with Title 10, Subtitle 2 of the State Government Article; and
(iv)
Provide that the retrospective review process be conducted by a licensed physician.