Bill > HB418

This bill modifies the reimbursement requirements for health maintenance organizations (HMOs) when paying nonparticipating healthcare providers. The bill establishes specific payment rates for different types of medical services, with particular focus on evaluation and management services. For trauma physicians providing care in trauma centers, HMOs must pay at least 140% of the Medicare rate or the rate as of January 1, 2001, whichever is greater. For other evaluation and management services, HMOs must pay at least 125% of the average rate paid as of January 31, 2019, adjusted by the Medicare Economic Index (a measure of price changes for physician services). The bill requires HMOs to disclose reimbursement rates upon request, allows HMOs to seek reimbursement from enrollees for certain claims, and provides mechanisms for healthcare providers to enforce these requirements, including filing complaints with the Maryland Insurance Administration or pursuing civil action. The bill also empowers the Maryland Health Care Commission to review HMO payments annually and allows the Insurance Commissioner to impose penalties up to $5,000 for repeated violations. The new regulations will take effect on October 1, 2025, providing HMOs time to adjust their payment practices to comply with the new requirements.

Health and Social Services

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/HB0418?ys=2025RS