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*sb0428*
SENATE BILL 428
J5, J1, J4 (6lr2139)
ENROLLED BILL
— Finance/Health —
Introduced by Senator Augustine
Read and Examined by Proofreaders:
_______________________________________________
Proofreader.
_______________________________________________
Proofreader.
Sealed with the Great Seal and presented to the Governor, for his approval this
_______ day of _______________ at _________________ _______ o’clock, ________M.
______________________________________________
President.
CHAPTER ______
AN ACT concerning 1
Maryland Medical Assistance Program and Health Insurance – Collaborative 2
Care Model – Cost Sharing Prohibition 3
FOR the purpose of prohibiting the Maryland Department of Health and certain insurers, 4
nonprofit health plans, and health maintenance organizations from imposing a 5
copay, coinsurance, or deductible for services provided in accordance with the 6
Collaborative Care Model; requiring certain insurers, nonprofit health plans, and 7
health maintenance organizations to provide coverage for services provided in 8
accordance with the Collaborative Care Model; requiring the Maryland Health Care 9
Commission to study the impact of eliminating health insurance cost –sharing for 10
services provided under the Collaborative Care Model by certain insurers, nonprofit 11
health plans, and health maintenance organizations; and generally relating to cost 12
sharing and the Collaborative Care Model. 13
BY repealing and reenacting, with amendments, 14
2 SENATE BILL 428
Article – Health – General 1
Section 15–141.1 2
Annotated Code of Maryland 3
(2023 Replacement Volume and 2025 Supplement) 4
BY adding to 5
Article – Insurance 6
Section 15–864 7
Annotated Code of Maryland 8
(2017 Replacement Volume and 2025 Supplement) 9
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 10
That the Laws of Maryland read as follows: 11
Article – Health – General 12
15–141.1. 13
(a) In this section, “Collaborative Care Model” means an evidence –based 14
approach for integrating somatic and behavioral health services in primary care settings 15
that includes: 16
(1) Care coordination and management; 17
(2) Regular, proactive outcome monitoring and treatment for outcome 18
targets using standardized outcome measurement rating scales and electronic tools, such 19
as patient tracking; and 20
(3) Regular systematic psychiatric and substance use disor der caseload 21
reviews and consultation with a psychiatrist, an addiction medicine specialist, or any other 22
behavioral health medicine specialist as allowed under federal regulations governing the 23
model. 24
(b) This section may not be construed to prohibit re ferrals from a primary care 25
provider to a specialty behavioral health care provider. 26
(c) The Department shall implement and provide reimbursement for services 27
provided in accordance with the Collaborative Care Model statewide in primary care 28
settings that provide health care services to Program recipients. 29
(D) THE DEPARTMENT MAY NOT IMPOSE A COPAYMENT, COINSURANCE, OR 30
DEDUCTIBLE REQUIREMENT FOR SERVICES PROV IDED IN ACCORDANCE W ITH THE 31
COLLABORATIVE CARE MODEL STATEWIDE IN PR IMARY CARE SETTINGS THAT 32
PROVIDE HEALTH CARE SERVICES TO PROGRAM RECIPIENTS. 33
SENATE BILL 428 3
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 1
as follows: 2
Article – Insurance 3
15–864. 4
(A) IN THIS SECTION, “COLLABORATIVE CARE MODEL” HAS THE MEANING 5
STATED IN § 15–141.1 OF THE HEALTH – GENERAL ARTICLE. 6
(B) THIS SECTION APPLIES TO: 7
(1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 8
PROVIDE COVERAGE FOR SERVICE S PROVIDED IN ACCORD ANCE WITH THE 9
COLLABORATIVE CARE MODEL UNDER INDIVIDUA L, GROUP, OR BLANKET 10
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS ON AN 11
EXPENSE–INCURRED BASIS UNDER HEALTH INSURANCE POL ICIES OR CONTRACTS 12
THAT ARE ISSUED OR DELIVERED IN THE STATE; AND 13
(2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 14
COVERAGE FOR SERVICES PROVIDED IN ACC ORDANCE WITH THE COLLABORATIVE 15
CARE MODEL UNDER INDIVIDUA L OR GROUP HOSPITAL, MEDICAL, OR SURGICAL 16
BENEFITS TO INDIVIDU ALS OR GROUPS UNDER CONTRACTS THAT ARE I SSUED OR 17
DELIVERED IN THE STATE. 18
(C) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS SUBSECTION, 19
AN ENTITY SUBJECT TO THIS SECTION MAY NOT IMPOSE A COPAYMENT , 20
COINSURANCE, OR DEDUCTIBLE REQUIR EMENT ON COVERAGE FO R SERVICES 21
PROVIDED IN ACCORDANCE WITH THE COLLABORATIVE CARE MODEL. 22
(2) IF AN INSURED OR ENRO LLEE IS COVERED UNDE R A 23
HIGH–DEDUCTIBLE HEALTH PLAN , AS DEFINED IN 26 U.S.C. § 223, AN ENTITY 24
SUBJECT TO THIS SECT ION MAY SUBJECT SERV ICES PROVIDED IN ACC ORDANCE 25
WITH THE COLLABORATIVE CARE MODEL TO THE DEDUCTIBLE REQUIREMENT OF 26
THE HIGH–DEDUCTIBLE HEALTH PLAN. 27
(C) AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE COVERAGE FOR 28
SERVICES PROVIDED IN ACCORDANCE WITH THE COLLABORATIVE CARE MODEL. 29
SECTION 3. AND BE IT FURTHER ENACTED, That on or before December 1, 2026, 30
the Maryland Health Care Commission shall: 31
(1) conduct a study in a ccordance with § 15 –1501 of the Insurance Article 32
on the impact of eliminating health insurance cost –sharing for services provided under the 33
4 SENATE BILL 428
Collaborative Care Model by insurers, nonprofit health service plans, and health 1
maintenance organizations that pro vide coverage for services provided in accordance with 2
the Collaborative Care Model under individual, group, or blanket health insurance policies 3
or contracts that are issued or delivered in the State; and 4
(2) report its findings and recommendations, i n accordance with § 2 –1257 5
of the State Government Article, to the Senate Finance Committee and the House Health 6
Committee. 7
SECTION 3. 4. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall 8
apply to all policies, contracts, and health benefit plans issued, delivered, or renewed in the 9
State on or after January 1, 2027. 10
SECTION 4. 5. AND BE IT FURTHER ENACTED, That Sections 2 and 3 4 of this 11
Act shall take effect January 1, 2027. 12
SECTION 5. 6. AND BE IT FURTHER ENACTED, That, except as provided in 13
Section 4 5 of this Act, this Act shall take effect July 1, 2026. 14
Approved: 15
________________________________________________________________________________
Governor. 16
________________________________________________________________________________
President of the Senate. 17
________________________________________________________________________________
Speaker of the House of Delegates. 18
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.