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*sb0521*
SENATE BILL 521
J5 6lr2522
By: Senator Kramer
Introduced and read first time: February 4, 2026
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 1, 2026
CHAPTER ______
AN ACT concerning 1
Health Insurance – Material Changes to Provider Networks – Notification and 2
Special Enrollment Period 3
FOR the purpose of requiring certain health systems to comply with certain insurance 4
provisions regarding notice of termination of contracts; altering the notification 5
requirements a carrier is required to provide an enrollee regarding changes to the 6
carrier’s provider panel; altering the notice req uirements a carrier is required to 7
provide to the Insurance Commissioner for certain material changes to the carrier’s 8
provider panel; requiring certain notice if a carrier and health system intend to 9
terminate certain contracts; requiring certain carriers and health systems to adhere 10
to the terms of certain contracts under certain circumstances; requiring certain 11
carriers to provide certain special enrollment periods for individuals who are 12
patients of certain providers that are terminated from certain pro vider panels; and 13
generally relating to material changes to carrier provider networks. 14
BY adding to 15
Article – Health – General 16
Section 19–310.7 17
Annotated Code of Maryland 18
(2023 Replacement Volume and 2025 Supplement) 19
BY repealing and reenacting, with amendments, 20
Article – Insurance 21
Section 15–112(b)(1)(ii)2. and, (c)(2), and (m) and 15–1316(a), (c), (d), (e), and (f) 22
Annotated Code of Maryland 23
2 SENATE BILL 521
(2017 Replacement Volume and 2025 Supplement) 1
BY adding to 2
Article – Insurance 3
Section 15–112(b)(4) and (y) 4
Annotated Code of Maryland 5
(2017 Replacement Volume and 2025 Supplement) 6
BY repealing and reenacting, without amendments, 7
Article – Insurance 8
Section 15–112(c)(1) 9
Annotated Code of Maryland 10
(2017 Replacement Volume and 2025 Supplement) 11
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 12
That the Laws of Maryland read as follows: 13
Article – Health – General 14
19–310.7. 15
(A) IN THIS SECTION , “HEALTH SYSTEM” HAS THE MEANING STAT ED IN § 16
15–112(Y) OF THE INSURANCE ARTICLE. 17
(B) A HEALTH SYSTEM SHALL COMP LY WITH § 15–112(Y) OF THE 18
INSURANCE ARTICLE. 19
Article – Insurance 20
15–112. 21
(b) (1) Subject to paragraph (3) of this subsection, a carrier that uses a 22
provider panel shall: 23
(ii) establish procedures to: 24
2. notify an enrollee of: 25
A. the termination from the carrier’s provider panel , 26
INCLUDING WHEN THE P ROVIDER ELECTS TO TE RMINATE PARTICIPATIO N FROM 27
THE PROVIDER PANEL , of the primary care provider that was furnishing health care 28
services to the enrollee AND ANY PROVIDER OF BEHAVIORAL HEALTH CARE SERVICES 29
FOR WHOM THE CARRIER HAS RECEIVED A CLAIM FOR SERVICES PERFORM ED ON 30
THE ENROLLEE WITHIN THE 3 MONTHS IMMEDIATELY PRECEDING THE DATE OF THE 31
TERMINATION; and 32
SENATE BILL 521 3
B. the right of the enrollee, on request, to continue to receive 1
health care services from the [enrollee’s primary care provider] PROVIDERS DESCRIBED 2
IN ITEM A OF THIS ITEM for up to 90 days after the date of the notice of termination of the 3
[enrollee’s primary care] provider from the carrier’s provider panel, if the termination was 4
for reasons unrelated to fraud, patient abuse, incompetency, or loss of licensure status; 5
(4) THE NOTICE REQUIRED U NDER PARAGRAPH (1)(II)2 OF THIS 6
SUBSECTION SHALL INCLUDE: 7
(I) CONTACT INFORMATION THAT THE ENROLLEE MAY USE TO 8
DIRECT COMMENTS OR CONCERNS TO THE CARRIER REGARDING THE TERMINATION 9
OF THE PROVIDER FROM THE CARRIER’S PROVIDER PANEL; 10
(II) INSTRUCTIONS ON HOW THE ENROLLEE MAY NOT IFY THE 11
CARRIER OF THE NEED FOR TRANSITIONAL CAR E AS DESCRIBED IN PA RAGRAPH 12
(1)(II)2B OF THIS SUBSECTION BY SUBMITTING A UNIF ORM FORM DEVELOPED B Y 13
THE COMMISSIONER UNDER SUBSECTION (Y)(4) OF THIS SECTION; AND 14
(III) THE TELEPHONE NUMBER AND E–MAIL ADDRESS FOR THE 15
OFFICE IN THE ADMINISTRATION THAT I S RESPONSIBLE FOR RE CEIVING AND 16
RESPONDING TO COMPLAINTS FROM ENROLLEES ABOUT CARRIERS. 17
(c) (1) This subsection applies to a carrier that: 18
(i) is an insurer, a nonprofit health service plan, or a health 19
maintenance organization; and 20
(ii) uses a provider panel for a health benefit plan offered by the 21
carrier. 22
(2) (i) On or before July 1, 2018, and annually thereafter, a carrier shall 23
file with the Commissioner for review by the Commissioner an access plan that meets the 24
requirements of subsection (b) of this section and any regulations adopted by the 25
Commissioner under subsections (b) and (d) of this section. 26
(ii) If the [carrier makes ] TERMINATION OF A PRO VIDER OR 27
HEALTH CARE FACILITY FROM THE CARRIER’S PROVIDER PANEL WILL RESULT IN a 28
material change to the access plan, the carrier shall: 29
1. SUBJECT TO SUBPARAGR APH (IV) OF THIS 30
PARAGRAPH, notify the Commissioner of the [change within 15 business days after the 31
change occurs ] IMPENDING TERMINATIO N AT LEAST 60 DAYS BEFORE THE 32
ANTICIPATED DATE OF TERMINATION; [and] 33
4 SENATE BILL 521
2. HAVE A C ONTINUING OBLIGATION TO UPDATE AND 1
SUPPLEMENT THE INITI AL AND SUBSEQUENT NO TIFICATIONS UNTIL TH E 2
TERMINATION IS EFFECTIVE OR AN AGREEMENT IS REACHED WITH THE PROVIDER 3
OR HEALTH CARE FACILITY; AND 4
[2.] 3. [include in the notice required under item 1 o f this 5
subparagraph a reasonable timeframe within which the carrier will ] SUBJECT TO 6
SUBPARAGRAPH (V) OF THIS PARAGRAPH , WITHIN 5 BUSINESS DAYS AFTER THE 7
EFFECTIVE DATE OF TH E TERMINATION, file with the Commissioner an update to the 8
existing access plan for review by the Commissioner. 9
(iii) The Commissioner may order corrective action if, after review, 10
the access plan is determined not to meet the requirements of this subsection. 11
(IV) THE NOTICE REQUIRED U NDER SUBPARAGRAPH (II)1 OF 12
THIS PARAGRAPH SHALL BE PROVIDED IF: 13
1. THE PROVIDER OR HEALTH CARE FACILITY PROVIDES 14
ADVANCE NOTICE TO TH E CARRIER OF ITS INT ENTION TO TERMINATE 15
PARTICIPATION IN THE CARRIER’S PROVIDER PANEL; 16
2. THE CARRIER PROVIDES ADVANCE NOTICE TO TH E 17
PROVIDER OR HEALTH C ARE FACILITY OF THE CARR IER’S INTENTION TO 18
TERMINATE THE PROVID ER OR HEALTH CARE FA CILITY FROM THE CARR IER’S 19
PROVIDER PANEL; 20
3. THE CURRENT TERM OF THE EXISTING NETWORK 21
PARTICIPATION CONTRACT BETWEEN THE CARRIER AND THE PROVIDER OR HEALTH 22
CARE FACILITY IS SET TO EXPIRE WITHIN 60 DAYS AND AN AGREEMENT TO EXTEND 23
OR RENEW THE CONTRACT HAS NOT BEEN REACHED; OR 24
4. THE CARRIER POSSESSES OTHER INFORMATION THAT 25
IT REASONABLY DETERM INES IS AN INDICATIO N THAT TERMINATION O F THE 26
PROVIDER OR HEALTH C ARE FACILITY FROM THE CARRIER ’S PROVIDER PANEL IS 27
LIKELY IN THE NEXT 60 DAYS. 28
(V) THE UPDATE TO THE EXISTING ACCESS PLAN REQUIRED TO 29
BE FILED UNDER SUBPA RAGRAPH (II)3 OF THIS PARAGRAPH IS REQUIRED TO 30
INCLUDE ONLY INFORMATION RELATED TO: 31
1. THE PROVIDER SPECIALTY TYPES AFFECTED BY THE 32
MATERIAL CHANGE; AND 33
SENATE BILL 521 5
2. UNLESS THE NETWORK A S A WHOLE EXPERIENCE D A 1
10% REDUCTION, THE GEOGRAPHIC AREAS WHERE ENROLLEES WERE AFFECTED BY 2
THE MATERIAL CHANGE. 3
(VI) THE COMMISSIONER MAY IMPO SE A FINE OF $5,000 PER 4
DAY FOR EACH DAY PAST 5 BUSINESS DAYS THAT T HE CARRIER FAILS TO FILE AN 5
UPDATE TO THE EXISTING ACCESS PLAN AS REQUIRED BY SUBPARAGRAPH (II)3 OF 6
THIS PARAGRAPH. 7
(m) (1) For at least 90 days after the date of the notice of termination of a 8
primary care provider OR A PROVIDER OF BEHAVIORAL HEALTH CARE SERVICES from 9
a carrier’s provider panel for reasons unrelated to fraud, patient abuse, incompetency, or 10
loss of licensure status, the [primary care] provider shall furnish health care services to 11
each enrollee: 12
(i) who was receiving health care services from the [primary care] 13
provider before the notice of termination; and 14
(ii) who, after receiving notice under subsection (b) of this section of 15
the termination of the [primary care] provider, requests to continue receiving health care 16
services from the [primary care] provider. 17
(2) A carrier shall reimburse a [primary care ] provider that furnishes 18
health care services under this subsection in accordance with the [primary care] provider’s 19
agreement with the carrier. 20
(3) A PROVIDER THAT FURNIS HES HEALTH CARE SERV ICES UNDER 21
THIS SUBSECTION IN A CCORDANCE WITH A PRO VIDER’S AGREEMENT WITH A 22
CARRIER SHALL ACCEPT AS PAYMENT IN FULL FOR THE SERVICES PAYMENT FROM 23
THE CARRIER AND COST–SHARING FROM THE PATIENT, AS APPLICABLE. 24
(Y) (1) IN THIS SUBSECTION, “HEALTH SYSTEM” MEANS: 25
(I) A HOSPITAL AND ANY E NTITY AFFILIATED WIT H THE 26
HOSPITAL THROUGH OWNERSHIP, GOVERNANCE, MEMBERSHIP, OR OTHER MEANS; 27
OR 28
(II) A PARENT CORPORATION OF ONE OR MORE HOSPITALS AND 29
ANY ENTITY AFFILIATED WITH THE PARENT CORPORATION THROUGH OWNERSHIP, 30
GOVERNANCE, MEMBERSHIP, OR OTHER MEANS. 31
(2) (I) A CARRIER AND A HEALTH SYSTEM SHALL PROVIDE TO 32
EACH OTHER WRITTEN N OTICE OF ANY INTENT TO TERMINATE A CONTR ACT 33
BETWEEN THE CARRIER AND THE HEALTH SYSTEM: 34
6 SENATE BILL 521
1. (I) AT LEAST 90 DAYS BEFORE THE PROP OSED DATE OF 1
TERMINATION OF THE CONTRACT; OR 2
2. (II) IN THE CASE OF A NON RENEWAL, AT LEAST 90 DAYS 3
BEFORE THE END OF THE CONTRACT PERIOD. 4
(II) A CARRIER SHALL MAKE A GOOD FAITH EF FORT TO 5
PROVIDE WRITTEN NOTI CE OF A TERMINATION AS REQUIRED UNDER 6
SUBPARAGRAPH (I) OF THIS PARAGRAPH TO ALL COVERED INDIVIDUALS WHO ARE 7
PATIENTS BEING TREATED ON A REGULAR BASIS BY OR AT THE HEALTH SYSTEM: 8
1. AT LEAST 30 DAYS BEFORE THE PROPOSED DATE OF 9
TERMINATION OF THE CONTRACT; OR 10
2. IN THE CASE OF A NON RENEWAL, AT LEAST 30 DAYS 11
BEFORE THE END OF THE CONTRACT PERIOD. 12
(3) (I) FOR EACH CONTRACT BETWEEN A CARRIER AND A HEALTH 13
SYSTEM THAT IS ENTERED INTO, RENEWED, AMENDED, OR CONTINUED ON OR AFTER 14
OCTOBER 1, 2026, IF THE CONTRACT IS N OT RENEWED OR IS TER MINATED BY THE 15
CARRIER OR THE HEALTH SYSTEM, THE CARRIER AND THE HEALTH SYSTEM SHALL 16
CONTINUE TO ADHERE T O THE TERMS OF THE C ONTRACT, INCLUDING 17
REIMBURSEMENT TERMS AND PATIENT BALANCE BILLING PROT ECTIONS FOR ALL 18
HEALTH CARE SERVICES PROVIDED UNDER THE CONTRACT, FOR A PERIOD OF: 19
1. AT LEAST 90 DAYS AFTER THE DATE OF TERMINATION; 20
OR 21
2. IN THE CASE OF A NON RENEWAL, AT LEAST 90 DAYS 22
AFTER THE END OF THE CONTRACT PERIOD. 23
(II) EXCEPT AS OTHERWISE A GREED TO BY A CARRIE R AND A 24
HEALTH SYSTEM, THE REIMBURSEMENT TERMS OF A CONTRACT ENTERED INTO BY 25
THE CARRIER AND THE HEALTH SYSTEM DURING THE 90–DAY PERIOD SHALL BE 26
RETROACTIVE TO: 27
1. THE DATE OF TERMINATION; OR 28
2. IN THE CASE OF A NONREN EWAL, THE END DATE OF 29
THE CONTRACT PERIOD. 30
SENATE BILL 521 7
(III) THIS PARAGRAPH DOES N OT APPLY IF THE CARR IER AND 1
HEALTH SYSTEM: 2
1. AGREE, IN WRITING , TO THE TERMINATION O R 3
NONRENEWAL OF THE CONTRACT; AND 4
2. PROVIDE THE NOTICES REQUIRED UNDER 5
PARAGRAPH (1) (2) OF THIS SUBSECTION. 6
(4) THE COMMISSIONER SHALL DE VELOP A UNIFORM FORM THAT 7
CARRIERS, PROVIDERS, AND HEALTH SYSTEMS S HALL USE FOR REQUEST S TO 8
CONTINUE TO RECEIVE HEALTH CARE SERVICES IN ACCORDANCE WITH SUBSECTION 9
(B) OF THIS SECTION OR 42 U.S.C. § 300GG–113. 10
15–1316. 11
(a) (1) In this section the following words have the meanings indicated. 12
(2) “Dependent” means an individual who is or who may become eligible 13
for coverage under the terms of a health benefit plan because of a relationship with another 14
individual. 15
(3) “Health care practitioner” has the meaning stated in § 1 –301 of the 16
Health Occupations Article. 17
(4) “PROVIDER” MEANS A HEALTH CARE PRACTITIONER OR A 18
HEALTH CARE FACILITY THAT PARTICIPATES ON A HEALTH BENEF IT PLAN ’S 19
PROVIDER PANEL. 20
[(4)] (5) “Qualifying coverage in an eligible employer –sponsored plan” 21
has the meaning stated in 45 C.F.R. § 155.300. 22
(c) A carrier participating in the Individual Exchange shall provide: 23
(1) the special enrollment periods specified in 45 C.F.R. § 155.420 for 24
individuals who purchase coverage through the Individual Exchange; [and] 25
(2) a special enrollment period for an individual who purchases coverage 26
through the Individual Exchange if the individual or a dependent of the individual becomes 27
pregnant, as confirmed by a health care practitioner; AND 28
(3) A SPECIAL ENROLLMENT PERIOD FOR AN INDIVI DUAL WHO 29
PURCHASES COVERAGE THROUGH THE INDIVIDUAL EXCHANGE IF THE INDIVIDUAL 30
OR A DEPENDENT OF THE INDIVIDUAL IS: 31
8 SENATE BILL 521
(I) A PATIENT BEING TREATED ON A REGULAR BASIS BY OR AT 1
A PROVIDER; AND 2
(II) ENROLLED IN A HEALTH BENEFIT PLAN IN WHIC H THE 3
PROVIDER TREATING THE INDIVIDUAL OR DEPE NDENT IS TERMINATED FROM THE 4
HEALTH BENEFIT PLAN’S PROVIDER PANEL. 5
(d) A carrier shall provide: 6
(1) the special enrollment periods specified in 45 C.F.R. § 147.104(b)(2) for 7
individuals who purchase coverage outside the Individual Exchange; [and] 8
(2) a special enrollment period for an individual who purchases coverage 9
outside the Individual Exchange if the individual or a dependent of the individual becomes 10
pregnant, as confirmed by a health care practitioner; AND 11
(3) A SPECIAL ENROLLMENT PERIOD FOR AN INDIVI DUAL WHO 12
PURCHASES COVERAGE OUTSIDE THE INDIVIDUAL EXCHANGE IF THE INDIV IDUAL 13
OR A DEPENDENT OF THE INDIVIDUAL IS: 14
(I) A PATIENT BEING TREATED ON A REGULAR BASIS BY OR AT 15
A PROVIDER; AND 16
(II) ENROLLED IN A HEALTH BENEFIT PLAN IN WHIC H THE 17
PROVIDER TREATING THE INDIVIDUAL OR DEPE NDENT IS TERMINATED FROM THE 18
HEALTH BENEFIT PLAN’S PROVIDER PANEL. 19
(e) (1) A special enrollment period described in subsection (c)(2) or (d)(2) of this 20
section shall: 21
[(1)] (I) be open for a period of 90 days; and 22
[(2)] (II) begin on the date the health care practitioner confirms the 23
pregnancy. 24
(2) A SPECIAL ENROLLMENT P ERIOD DESCRIBED IN S UBSECTION 25
(C)(3) OR (D)(3) OF THIS SECTION SHALL: 26
(I) BE OPEN FOR A PERIOD OF 90 DAYS; AND 27
(II) BEGIN ON: 28
1. THE DATE OF TERMINATION OF THE PROVIDER FROM 29
THE HEALTH BENEFIT PLAN’S PROVIDER PANEL; OR 30
SENATE BILL 521 9
2. IF THE CONSUMER DID NOT RECEIVE NOTICE OF THE 1
TERMINATION BEFORE T HE TERMINATION DATE , THE DATE OF THE NOTI CE OF 2
TERMINATION. 3
(f) (1) If an individual enrolls for coverage during one of the open enrollment 4
periods described in subsection (b) o f this section or during one of the special open 5
enrollment periods described in subsections (c)(1) and (d)(1) of this section, coverage shall 6
be effective in accordance with the requirements in 45 C.F.R. § 155.420. 7
(2) If an individual enrolls for coverage or enrolls a dependent for coverage 8
during a special enrollment period described in subsection (c)(2) or (d)(2) of this section, the 9
coverage shall become effective on the first day of the month in which the individual 10
receives confirmation of pregnancy. 11
(3) IF AN INDIVIDUAL ENRO LLS FOR COVERAGE OR ENROLLS A 12
DEPENDENT FOR COVERAGE DURING A SPECIAL ENROLLMENT PERIOD DESCRIBED 13
IN SUBSECTION (C)(3) OR (D)(3) OF THIS SECTION, THE INDIVIDUAL SHALL SELECT 14
IF COVERAGE SHALL BECOME EFFECTIVE: 15
(I) ON THE FIRST DAY OF THE MON TH FOLLOWING THE DAT E 16
THE HEALTH BENEFIT PLAN WAS SELECTED; OR 17
(II) ON THE FIRST DAY OF THE MONTH IN WHICH T HE 18
TERMINATION OF THE P ROVIDER ON THE HEALT H BENEFIT PLAN ’S PROVIDER 19
PANEL BECAME EFFECTIVE. 20
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 21
October 1, 2026. 22
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.