Emergency Room Services and Post-Acute Care - Coverage and Facility Studies

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb1563*

HOUSE BILL 1563
J1, J3, J5 6lr2861

By: The Speaker and Delegate Bhandari and Delegates Bhandari, Alston, Bagnall,
Cullison, Guzzone, Hill, Hutchinson, S. Johnson, Kaufman, Kipke, Lopez,
Martinez, Rosenberg, Ross, Taveras, White Holland, and Woorman
Introduced and read first time: February 13, 2026
Assigned to: Health
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 3, 2026

CHAPTER ______

AN ACT concerning 1

Emergency Room Services and Post–Acute Care – Coverage and Facility Studies 2

FOR the purpose of prohibiting certain policies and contracts issued by insurers, nonprofit 3
health service plans, and health maintenance organizations from denying insurance 4
coverage for certain emergency room services under certain circumstances 5
authorizing the Maryland Insurance Commissioner to conduct an examination of 6
certain decisions by carriers related to claims or authorization requests for services 7
in, or related to services in, emergency departments; authorizing the Commissioner 8
to have certain decisions independently reviewed under certain circumstances ; 9
requiring that a certain report required to be compiled by the Maryland Insurance 10
Commissioner include data on certain adverse decisions and grievances; requiring 11
the Maryland Health Care Commission, in conjunction with the Health Services Cost 12
Review Commission, to condu ct a study to quantify bed capacity in hospitals and 13
post–acute settings in the State and make a recommendation on a certain collection 14
and auditing process; requiring the Maryland Health Care Commission, in 15
consultation with the Health Services Cost Revie w Commission, to study analyzing 16
options to facilitate clinically appropriate transitions from acute to post –acute care 17
settings in the State; and generally relating to emergency room services and 18
post–acute care. 19

BY repealing and reenacting, without amendments, 20
Article – Insurance 21
Section 15–1A–14 22
2 HOUSE BILL 1563

Annotated Code of Maryland 1
(2017 Replacement Volume and 2025 Supplement) 2

BY repealing and reenacting, with amendments, 3
Article – Insurance 4
Section 15–10A–06 5
Annotated Code of Maryland 6
(2017 Replacement Volume and 2025 Supplement) 7

BY adding to 8
Article – Insurance 9
Section 15–504 15–10B–21 10
Annotated Code of Maryland 11
(2017 Replacement Volume and 2025 Supplement) 12

BY repealing and reenacting, with amendments, 13
Article – Insurance 14
Section 15–10A–06 15
Annotated Code of Maryland 16
(2017 Replacement Volume and 2025 Supplement) 17

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 18
That the Laws of Maryland read as follows: 19

Article – Insurance 20

15–1A–14. 21

(a) (1) In this section the following words have the meanings indicated. 22

(2) “Emergency medical condition” means a medical condition, including a 23
mental health condition or substance use disorder, that manifests itself by acute symptoms 24
of such severity, including severe pain, that the abse nce of immediate medical attention 25
could reasonably be expected by a prudent layperson, who possesses an average knowledge 26
of health and medicine, to result in a condition described in § 1867(e)(1) of the Social 27
Security Act. 28

(3) (i) “Emergency services ” means, with respect to an emergency 29
medical condition: 30

1. a medical screening examination that is within the 31
capability of the emergency department of a hospital or freestanding medical facility, 32
including ancillary services routinely available to t he emergency department to evaluate 33
an emergency medical condition; 34

2. any other examination or treatment within the 35
capabilities of the staff and facilities available at the hospital or freestanding medical 36
HOUSE BILL 1563 3

facility that is necessary to stabilize the patient, regardless of the department of the 1
hospital in which the examination or treatment is furnished; or 2

3. except as provided in subparagraph (iii) of this paragraph, 3
additional covered items and services furnished by a health care provider of e mergency 4
services that does not have a contractual relationship with the carrier after the patient is 5
stabilized and as part of outpatient observation or an inpatient or outpatient stay with 6
respect to the visit in which the services described in items 1 a nd 2 of this subparagraph 7
are furnished. 8

(ii) “Emergency services” includes services described in 9
subparagraph (i) of this paragraph that are provided in specialized facilities that are staffed 10
by behavioral health providers trained to provide crisis services. 11

(iii) Subject to § 14–205.2 of this article and § 19–710(p) of the Health 12
– General Article, “emergency services” does not include items and services described in 13
subparagraph (i)3 of this paragraph if all of the conditions in 45 C.F.R. § 149. 410(b) are 14
met. 15

(b) If a carrier provides or covers any benefits for emergency services in an 16
emergency department of a hospital or freestanding medical facility, the carrier: 17

(1) may not require prior authorization for the emergency services; 18

(2) shall provide coverage for the emergency services regardless of whether 19
the health care provider providing the emergency services has a contractual relationship 20
with the carrier to furnish emergency services; 21

(3) may not limit what constitutes an emerge ncy medical condition solely 22
on the basis of diagnosis codes; and 23

(4) may not impose any other term or condition on the coverage for 24
emergency services, except for: 25

(i) the exclusion or coordination of benefits; 26

(ii) a waiting period; and 27

(iii) applicable cost–sharing. 28

(c) If a health care provider of emergency services does not have a contractual 29
relationship with the carrier to provide emergency services, the carrier: 30

(1) may not impose any administrative requirement or limitation on 31
coverage that would be more restrictive than administrative requirements or limitations 32
imposed on coverage for emergency services furnished by a health care provider with a 33
contractual relationship with the carrier; 34
4 HOUSE BILL 1563

(2) subject to § 14 –205.2 of this article and § 19 –710.1 of the 1
Health – General Article, may not impose any cost –sharing amount greater than the 2
amount imposed for emergency services furnished by a health care provider with a 3
contractual relationship with the carrier; 4

(3) shall calculate and apply the cost–sharing amounts in accordance with 5
the requirements of 45 C.F.R. § 149.110(b)(3)(iii) and (v); and 6

(4) except as provided in § 14 –205.2 of this article and § 19 –710.1 of the 7
Health – General Article, shall reimburse the health care provider in accordance with the 8
requirements of 45 C.F.R. § 149.110(b)(3)(iv). 9

15–504. 10

AN INDIVIDUAL , GROUP, OR BLANKET POLICY OR CONTRACT ISSUED OR 11
DELIVERED IN THE STATE BY AN INSURER , A NONPROFIT HEALTH S ERVICE PLAN, 12
OR A HEALTH MAINTENA NCE ORGANIZATION MAY NOT DENY A COVERED 13
EMERGENCY ROOM SERVI CE SOLELY ON THE BAS IS THAT THE INSURED OR 14
ENROLLEE DID NOT EXPERIENCE AN EMERGENCY MEDICAL CONDITION, AS DEFINED 15
IN § 15–1A–14 OF THIS TITLE. 16

SECTION 2. AND BE IT FURTHER EN ACTED, That the Laws of Maryland read 17
as follows: 18

Article – Insurance 19

15–10A–06. 20

(a) (1) On a quarterly basis, each carrier shall submit to the Commissioner, on 21
the form the Commissioner requires, a report that describes the following information 22
aggregated by zip code as required by the Commissioner: 23

(i) the number of members entitled to health care benefits under a 24
policy, plan, or certificate issued or delivered in the State by the carrier; 25

(ii) the number of clean claims for reimbursement pr ocessed by the 26
carrier; 27

(iii) the activities of the carrier under this subtitle, including: 28

1. the outcome of each grievance filed with the carrier; 29

2. the number and outcomes of cases that were considered 30
emergency cases under § 15–10A–02(b)(2)(i) of this subtitle; 31

HOUSE BILL 1563 5

3. the time within which the carrier made a grievance 1
decision on each emergency case; 2

4. the time within which the carrier made a grievance 3
decision on all other cases that were not considered emergency cases; 4

5. the number of grievances filed with the carrier that 5
resulted from an adverse decision involving length of stay for inpatient hospitalization as 6
related to the medical procedure involved; 7

6. the number of adverse decisions issued by the carr ier 8
under § 15 –10A–02(f) of this subtitle, whether the adverse decision involved a prior 9
authorization or step therapy protocol, the type of service at issue in the adverse decisions, 10
and whether an artificial intelligence, algorithm, or other software tool was used in making 11
the adverse decision; 12

7. the number of adverse decisions overturned after a 13
reconsideration request under § 15–10B–06 of this title; and 14

8. the number of requests made and granted under § 15
15–831(c)(1) and (2) of this title; and 16

(iv) the number and outcome of all other cases that are not subject to 17
activities of the carrier under this subtitle that resulted from an adverse decision involving 18
the length of stay for inpatient hospitalization as related to the medical procedure involved. 19

(2) If the number of adverse decisions issued by a carrier for a type of 20
service has grown by 10% or more in the immediately preceding calendar year or 25% or 21
more in the immediately preceding 3 calendar years, the carrier shall submit in the report 22
required under paragraph (1) of this subsection: 23

(i) a description of any changes in medical management 24
contributing to the rise in adverse decisions for the type of service; 25

(ii) any other known reasons for the increase; and 26

(iii) a description of the carrier’s efforts and actions taken to 27
determine the reason for the increase. 28

(b) The Commissioner shall: 29

(1) compile an annual summary report based on the information provided: 30

(i) under subsection (a) of this section; and 31

(ii) by the Secretary under § 19 –705.2(e) of the Health – General 32
Article; 33
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(2) INCLUDE IN THE SUMMARY REPORT DATA ON ADVERSE DECISIONS 1
AND GRIEVANCES RELAT ED TO POST –ACUTE SERVICES , INCLUDING ADVERSE 2
DECISIONS AND GRIEVA NCES RELATING TO ADM ISSIONS TO SK ILLED NURSING 3
FACILITIES AND INPATIENT REHABILITATION FACILITIES; 4

[(2)] (3) report any violations or actions taken under § 15–10B–11 of this 5
title; and 6

[(3)] (4) provide copies of the summary report to the Governor and, 7
subject to § 2–1257 of the State Government Article, to the General Assembly. 8

(c) The Commissioner may use information provided under subsection (a) of this 9
section as the basis for an examination under Title 2, Subtitle 2 of this article. 10

15–10B–21. 11

(A) THE COMMISSIONER MAY CONDUCT AN EXAMINATI ON OF A CARRIER 12
THAT HAS ISSUED A PA TTERN OF ADVERSE DEC ISIONS OR GRIEVANCE DECISIONS 13
FOR A CLAIM OR AUTHO RIZATION REQUEST FOR SERVICES IN , OR RELATED TO 14
SERVICES IN, AN EMERGENCY DEPARTMENT. 15

(B) A CARRIER EXAMINED UNDER SUBSECTION (A) OF THIS SECTION SHALL 16
PRODUCE ALL DOCUMENT S RELATED TO AN ADVE RSE DECISION OR GRIE VANCE 17
DECISION DESCRIBED U NDER SUBSECTION (A) OF THIS SECTION , INCLUDING 18
DOCUMENTS OR ELECTRO NIC DOCUMENTS IN THE POSSESSION OF A PRIV ATE 19
REVIEW AGENT ACTING ON BEHALF OF THE CARRIER. 20

(C) (1) THE COMMISSIONER MAY HAVE AN ADVERSE DECISION OR 21
GRIEVANCE DECISION D ESCRIBED UNDER SUBSE CTION (A) OF THIS SECTION 22
REVIEWED BY AN INDEPENDENT REVIEW ORGANIZATION. 23

(2) THE COSTS OF A REVIEW CONDUCTED UNDER PARAGRAPH (1) OF 24
THIS SUBSECTION SHALL BE PAID BY THE CARRIER. 25

SECTION 3. 2. AND BE IT FURTHER ENACTED, That: 26

(a) The Maryland Health Care Commission, in conjunction with the Health 27
Services Cost Review Commission and representatives from the post–acute care industry, 28
shall: 29

(1) conduct a study to quantify bed capacity in post–acute care settings and 30
in hospitals in the State; and 31

HOUSE BILL 1563 7

(2) make recommendations regarding a collection and auditing process by 1
which hospital and post –acute beds will be reported to the Maryland Heal th Care 2
Commission or the Health Services Cost Review Commission each year. 3

(b) The study required under subsection (a) of this section shall include: 4

(1) a count of the number of physical beds within each post –acute care 5
facility in the State; 6

(2) the use of a standardized definition for each inpatient and outpatient 7
bed type including Adult Medical, Adult Surgical, Adult Gynecological, Adult Addictions, 8
Adult Obstetric, Adult Psychiatric, Adult Rehabilitation, Pediatric, Inpatient Observation, 9
Outpatient Observation, Observation Swing, and other types as determined jointly by the 10
Commissions; 11

(3) a count of the number of physical beds, using the standardized 12
definition, within each hospital in the State, by bed type; 13

(4) a count of the number of staffed beds, using the standardized definition, 14
within each post–acute care facility in the State; 15

(5) a count of the number of staffed beds, using the standardized definition, 16
within each hospital in the State, by bed type; 17

(6) a count of the n umber of licensed beds within each post –acute care 18
facility in the State; 19

(7) a count of the number of licensed beds within each hospital in the State, 20
by bed type; 21

(8) a count of the number of other types of beds as determined appropriate; 22
and 23

(9) any other information necessary for the Maryland Health Care 24
Commission and the Health Services Cost Review Commission to quantify bed capacity in 25
the State. 26

(c) On or before January 1, 2027, the Maryland Health Care Commission, in 27
conjunction with the Health Services Cost Review Commission, shall report the findings of 28
the study conducted under this section and its recommendation regarding the process 29
described in subsection (a)(2) of this section to the Governor and, in accordance with § 30
2–1257 of th e State Government Article, the Senate Finance Committee and the House 31
Health Committee. 32

SECTION 4. 3. AND BE IT FURTHER ENACTED, That: 33

8 HOUSE BILL 1563

(a) The Maryland Health Care Commission, in consultation with the Health 1
Services Cost Review Commission and representatives from the post–acute care industry, 2
shall conduct a study analyzing options to facilitate clinically appropriate transitions from 3
acute to post–acute care settings. 4

(b) The study conducted under subsection (a) of this section shall include: 5

(1) an analysis of the factors affecting efficiency of clinically appropriate 6
transitions from acute to post–acute care settings; 7

(2) identification of potential solutions that can address the factors 8
analyzed under item (1) of this subsection; and 9

(3) any other information necessary for the Maryland Health Care 10
Commission or the Health Services Cost Review Commission to analyze options for 11
clinically appropriate transitions from acute to post–acute care settings. 12

(c) On or before January 1, 20 27, the Maryland Health Care Commission, in 13
conjunction with the Health Services Cost Review Commission, shall report its findings 14
and recommendations to the Governor and, in accordance with § 2 –1257 of the State 15
Government Article, the Senate Finance Committee and the House Health Committee. 16

SECTION 5. AND BE IT FURTHER ENACTED, That Section 1 of this Act shall 17
apply to all policies, contracts, and health benefit plans issued, delivered, or renewed in the 18
State on or after January 1, 2027. 19

SECTION 6. AND BE IT FURTHER ENACTED, That Section 1 of this Act shall take 20
effect January 1, 2027. 21

SECTION 7. 4. AND BE IT FURTHER ENACTED, That , except as provided in 22
Section 6 of this Act, this Act shall take effect June 1, 2026. 23

Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.