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EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
*hb0917*
HOUSE BILL 917
J5 6lr2503
By: Delegates Hill, Alston, Kaufman, Taylor, and Woods
Introduced and read first time: February 5, 2026
Assigned to: Health
A BILL ENTITLED
AN ACT concerning 1
Health Insurance – Retroactive Denial of Reimbursement 2
FOR the purpose of altering the circumstances under which a carrier may retroactively 3
deny reimbursement; altering the information a carrier is required to prov ide to a 4
health care provider if the carrier retroactively denies reimbursement; prohibiting a 5
carrier from retroactively denying reimbursement under certain circumstance s; 6
requiring certain carriers that retroactively deny reimbursement to develop a certain 7
training plan for health care providers; and generally relating to health insurance 8
and the retroactive denial of reimbursement. 9
BY repealing and reenacting, with amendments, 10
Article – Insurance 11
Section 15–1008(c) 12
Annotated Code of Maryland 13
(2017 Replacement Volume and 2025 Supplement) 14
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
That the Laws of Maryland read as follows: 16
Article – Insurance 17
15–1008. 18
(c) (1) [If a] A carrier MAY retroactively [denies] DENY reimbursement to a 19
health care provider[, the carrier] ONLY IF: 20
(i) [may only retroactively deny ] THE RETROACTIVE DENIAL OF 21
reimbursement IS for services subject to coordination of benefits with another carrier, the 22
Maryland Medical Assistance Program, or the Medicare Program AND IS MADE during the 23
18–month period after the date that the carrier paid the health care provider; and 24
2 HOUSE BILL 917
(ii) except as provided in item (i) of this paragraph, [may only 1
retroactively deny reimbursement ] THE CARRIER HAS PREV IOUSLY PROVIDED THE 2
HEALTH CARE PROVIDER WITH TRAINING ON REI MBURSEMENT PROTOCOLS , 3
BILLING STANDARDS , AND COMPLIANCE REQUI REMENTS RELATED TO T HE 4
RETROACTIVE DENIAL O F REIMBURSEMENT AND THE DENIAL IS MADE during the 5
[6–month] 3–MONTH period after the date that the [carrier paid the] health care provider 6
PROVIDED THE SERVICES. 7
(2) (i) A carrier that retroactively denies reimbursement to a health 8
care provider under paragraph (1) of this subsection shall provide the health care provider 9
with a written statement specifying the basis for the retroactive denial AND ANY 10
SUPPORTING DOCUMENTS OR CALCULATIONS. 11
(ii) If the retroactive denial of reimbursement results from 12
coordination of benefits by a carrier that is not a managed care organi zation, the written 13
statement shall provide the name and address of the entity acknowledging responsibility 14
for payment of the denied claim. 15
(3) A CARRIER MAY NOT RETR OACTIVELY DENY REIMB URSEMENT 16
FOR A SERVICE: 17
(I) BASED ON THE OUTCOME OF THE SERVICE; OR 18
(II) 1. BEFORE HAVING A CONVERSATION WITH THE HEALTH 19
CARE PROVIDER IN WHICH THE HEALTH CARE PROVIDER IS GIVEN THE 20
OPPORTUNITY TO EXPLA IN THE CIRCUMSTANCES , RATIONALE, OR JUSTIFICATION 21
FOR THE SERVICE BEIN G CONSIDERED FOR RET ROACTIVE DENIAL OF 22
REIMBURSEMENT; AND 23
2. WITHOUT TAKING INTO ACCOUNT THE TOTALITY OF 24
THE CIRCUMSTANCES AS VIEWED PROSPECTIVELY BASED ON THE CIRCUMSTANCES, 25
RATIONALE, OR JUSTIFICATION OFFERED BY THE HEALTH CARE PROVIDER UNDER 26
ITEM 1 OF THIS ITEM. 27
(4) EACH CARRIER THAT RETROACTIVELY DENIES REIMBURSEMENT 28
SHALL DEVELOP A PLAN FOR TRAINING HEALTH CARE PROVIDER S ON 29
REIMBURSEMENT PROTOC OLS, BILLING STANDARDS , AND COMPLIANCE 30
REQUIREMENTS RELATED TO THE RETROACTIVE DENIAL OF REIMBURSEMENT. 31
(5) THIS SUBSECTION MAY NOT BE CONSTRUED TO PROHIBIT A 32
HEALTH CARE PROVIDER OR INSURED FROM APPE ALING A RETROACTIVE DENIAL 33
OR REIMBURSEMENT AS OTHERWISE AUTHORIZED UNDER THIS TITLE. 34
HOUSE BILL 917 3
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 1
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 2
after January 1, 2027. 3
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 4
January 1, 2027. 5