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<section article="ghg" article_name="Health - General" number="15-158" title_number="15" title_name="Assistance Programs" subtitle_number="1" subtitle_name="Medical and Pharmacy Assistance Programs">
  <level label="a">
    <level label="1">
      <text>Subject to paragraph (2) of this subsection, the Program may not require prior authorization for a transfer to a special pediatric hospital.</text>
    </level>
    <level label="2">
      <text>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.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>On or before December 31, 2026, the Department shall adopt regulations establishing a retrospective review process for special pediatric hospitals.</text>
    </level>
    <level label="2">
      <text>The regulations adopted under paragraph (1) of this subsection shall:</text>
      <level label="i">
        <text>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;</text>
      </level>
      <level label="ii">
        <text>Provide for retrospective review of any medical necessity determination issued by the Department or its agent denying:</text>
        <level label="1">
          <text>Admission to a special pediatric hospital on or after January 1, 2025; or</text>
        </level>
        <level label="2">
          <text>Reimbursement for inpatient services or outpatient services provided by a special pediatric hospital on or after January 1, 2025;</text>
        </level>
      </level>
      <level label="iii">
        <text>Comply with Title 10, Subtitle 2 of the State Government Article; and</text>
      </level>
      <level label="iv">
        <text>Provide that the retrospective review process be conducted by a licensed physician.</text>
      </level>
    </level>
  </level>
</section>
