Bill > SB437

This bill modifies the requirements for health maintenance organizations (HMOs) when reimbursing non-contracted healthcare providers. Specifically, the bill updates how HMOs calculate reimbursement rates for different types of medical services. For trauma physicians providing care in trauma centers, HMOs must pay either 140% of the Medicare rate or the rate that was in place as of January 1, 2001, whichever is greater. For other healthcare providers, the bill changes the baseline reimbursement calculation for evaluation and management services and other services. Instead of using the previous year's rate, HMOs must now use the rate as of January 31, 2019, and adjust it annually based on the Medicare Economic Index (a measure of price changes for physician services). The bill also requires HMOs to disclose reimbursement rates upon request, allows providers to file complaints or civil actions if rates are not properly paid, and empowers the Maryland Insurance Administration to investigate and penalize HMOs for repeated violations. The Maryland Health Care Commission will annually review compliance with these new payment requirements. The changes will take effect on October 1, 2025, providing time for HMOs and healthcare providers to adapt to the new reimbursement framework.

Budget and Finance

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/SB0437?ys=2025RS