New Healthcare Regulations Impacting Virginia, Maryland, and D.C. Insurance

On January 1, 2026, significant legislative changes will take effect across Virginia, Maryland, and Washington D.C., profoundly impacting the insurance and healthcare sectors. These updates highlight AI-driven prior authorization delays and regulatory compliance requirements, challenging both payers and providers to adapt swiftly.

Virginia Legislation

The new Virginia legislative updates emphasize healthcare provisions, particularly cancer screenings. Under HB 1828, insurance providers must now cover costs for diagnostic or follow-up breast examinations such as mammograms, MRIs, and ultrasounds. Similarly, SB 1314 mandates coverage for enhanced prostate cancer screenings for men over 50, or 40 and above if considered high-risk, impacting regulatory compliance requirements for carriers.

Maryland Legislation

Maryland introduces significant changes to medical billing practices. Insurance entities, including those tied to Medicare and Medicaid, must cover recommended anesthesia procedures without time constraints. Furthermore, self-insured health plans must now include preventive cancer screenings for firefighters, as initiated by the James “Jimmy” Malone Act. The removal of time limits on anesthesia delivery is a strategic move to shield beneficiaries from surprise medical billing.

Washington D.C. Legislation

Washington D.C.'s healthcare coverage is set to adjust within the 2026 fiscal year budget, altering Medicaid eligibility criteria for adult residents without dependent children. Changes in ambulance fee structures, increasing from $1,750 to $2,000 for life support transport, could impact insurance claims. This presents new dynamics in underwriting and risk management for carriers operating in the region.

Industry Implications

Insurance companies must ensure regulatory compliance by aligning policies with these new regulations. Actuaries and underwriters need to assess the financial impacts, particularly regarding the expanded coverage in Virginia and Maryland, and reimbursement adjustments in Washington D.C. Providers need to adjust claims processing protocols to meet these evolving requirements, promoting expanded access to healthcare while maintaining financial integrity. Adapting to this regulatory landscape is crucial for supporting the insurance industry's future growth and sustainability.