Maryland law adds notice and enrollment options when providers leave plans

Carriers must tell the state insurance commissioner in advance about certain provider or facility departures that could materially change access to care. This applies to carriers that use provider panels for health plans when a provider’s or facility’s departure would materially change the carrier’s access plan. Notice is required when the provider or facility or carrier gives advance notice of departure, a contract is due to expire within 60 days without a renewal agreement, or the carrier reasonably believes departure is likely within 60 days. The access plan update must cover affected provider types and, unless the whole network shrank by 10%, the affected geographic areas. Advance notice is due at least 60 days before the expected departure. The access plan update is due within five business days after the departure takes effect.

Carriers must give members notice about certain provider departures, and certain providers must continue care when a member asks. The notice covers members whose primary care provider leaves the panel and members with a recent claim for care from a departing behavioral health provider. Notice covers a primary care provider and a behavioral health provider for whom the carrier received a claim for the member in the three months before departure. For departures unrelated to fraud, patient abuse, incompetence, or loss of a license, a member may ask to continue care for up to 90 days after the notice. The provider must accept the carrier’s payment and any patient cost-sharing as payment in full. The 90-day care period starts on the date of the termination notice.

Carriers and health systems must give written notice before ending or not renewing a contract, and carriers must try in good faith to notify regularly treated patients. A health system includes a hospital and its affiliated entities, or a parent corporation of hospitals and its affiliated entities. For covered contracts, the parties generally must keep following the contract, including payment terms and protections from patient balance bills, for at least 90 days after termination or the end of the contract period. This continuation rule does not apply if both sides agree in writing to end or not renew the contract and provide the required notices. The 90-day notice is due before the proposed end date or, for nonrenewal, before the contract period ends. The 30-day patient notice is due before that date. The contract continuation rule applies to contracts entered, renewed, amended, or continued on or after October 1, 2026.

Carriers must offer a special 90-day enrollment period to certain patients whose treating provider leaves their plan’s network. This applies to people buying coverage through or outside Maryland’s Individual Exchange, including when the regularly treated patient is their dependent. The person or their dependent must be regularly treated by or at the provider, and that provider must leave the person’s health plan network. When choosing coverage, the person selects whether it starts the first day of the month after choosing a plan or the first day of the month when the provider’s departure took effect. The enrollment period starts on the provider’s departure date. If the person did not receive notice before then, it starts on the date notice arrives.