Bill > HB995

This bill establishes a Workgroup to Study the Rise in Adverse Decisions in the State Health Care System, which will be composed of 16 members representing various healthcare stakeholders, including legislators, state agency representatives, hospital and insurance industry representatives, and patient advocates. The Workgroup's primary responsibilities include reviewing existing adverse decision reporting requirements across health payers in the state, analyzing data such as the number of adverse decisions compared to total claims processed, the number of enrollees in health plans, and diagnostic information for adverse decisions. They will develop recommendations to improve state reporting on adverse decisions by creating standardized definitions for medical service categories, health settings, adverse decisions, and medical necessity, as well as establishing consistent methods for categorizing adverse decisions and prior authorization denials. The Workgroup will also develop strategies to reduce the number of adverse decisions and propose potential legislative changes to address this issue. Members will not receive compensation but can be reimbursed for expenses, and the Health Services Cost Review Commission and Maryland Insurance Administration will provide staff support. The Workgroup is required to submit its findings and recommendations to specific legislative committees by December 1, 2025, and the bill will be in effect from June 1, 2025, to June 30, 2026.

Budget and Finance, Health and Social Services

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/HB0995?ys=2025RS