Bill > SB475

This bill introduces new regulations for health insurance carriers participating in two-sided incentive arrangements, which are contracts between carriers and eligible providers (licensed physicians or groups of healthcare practitioners) that include financial incentives and potential fund recoupment based on performance. Under the bill, carriers are prohibited from imposing prior authorization, step therapy, or quantity limit requirements on eligible providers for healthcare services included in these arrangements. The bill defines specific contract requirements, such as establishing a target budget for total patient care costs, limiting carrier recoupment to 50% of excess costs, capping total recoupment at 10% of annual payments, and ensuring the provider has greater potential for gains than the carrier does for recoupment. Carriers must also provide quarterly disclosures about payment details and cannot amend the arrangement during the contract term without mutual agreement. The provisions will apply to health insurance policies, contracts, and benefit plans issued or renewed in Maryland on or after January 1, 2026, with the aim of promoting value-based care by reducing administrative barriers for providers participating in these innovative payment models.

Budget and Finance

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/SB0475?ys=2025RS