# Health - General (GHG)

## Title 15. Assistance Programs

### Subtitle 1. Medical and Pharmacy Assistance Programs

#### Section 15-158

(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.

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Md. Code Ann., Health-Gen. (as displayed at mgaleg.maryland.gov, October 16, 2026)