<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".26-3" citation="COMAR 10.67.06.26-3" title_num="10" subtitle_num="67" chapter_num="06" heading="Gender- Affirming Treatment.">
  <paragraph num="A.">
    <text>An MCO shall provide medically necessary gender-affirming treatment services which include but are not limited to the following:</text>
    <paragraph num="(1)">
      <text>Hormone therapy, hormone blockers, and puberty blockers;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Hair alteration for the purposes of altering secondary sex characteristics and surgical site preparation;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Alterations to voice, voice therapy, and voice lessons;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Alterations to abdomen, chest, trunk, and buttocks;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Alterations to the face and neck;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Alterations to the genitals and gonads;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Laser treatment for scars from gender-affirming treatment;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Standard fertility preservation procedures as set forth in Insurance Article, §15-810.1, Annotated Code of Maryland;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Revisions to previous treatments and reversal of treatments;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Combinations of gender-affirming procedures; and</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Other treatments as prescribed to suppress the development of endogenous secondary sex characteristics, align the individual’s appearance of physical body with gender identity, and alleviate symptoms of clinically significant distress resulting from gender dysphoria.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>An MCO may not issue an adverse benefit determination denying or limiting access to gender-affirming treatment unless a health care provider with experience prescribing or delivering gender-affirming treatment has reviewed and confirmed the appropriateness of the adverse benefit determination.</text>
  </paragraph>
</regulation>