Bill > HB737

This bill modifies how Health Maintenance Organizations (HMOs), which are organizations that provide health insurance, are required to pay healthcare providers who are not part of their network (nonparticipating providers) for services rendered to their members, known as enrollees. Specifically, it updates the reimbursement rates for certain services. For trauma care provided by a trauma physician in a designated trauma center to a trauma patient, the HMO must pay the greater of 140% of what Medicare pays for the same service to a similarly licensed provider, or the rate paid as of January 1, 2001, to a similarly licensed provider in the same geographic area. For other healthcare providers, the bill adjusts the payment for evaluation and management services (routine check-ups and consultations) to be at least 125% of the average rate the HMO paid to in-network providers for that service as of January 31, 2019, adjusted annually by the Medicare Economic Index (a measure of price changes for physician services), or 140% of the Medicare rate as of August 1, 2008, also adjusted by the Medicare Economic Index. For services that are not evaluation and management services, the HMO must pay at least 125% of the average rate paid to in-network providers as of January 31, 2019, adjusted annually by the Medicare Economic Index. The bill also clarifies definitions for terms like "similarly licensed provider" and "trauma center," and establishes procedures for enforcement and penalties for non-compliance, with the Maryland Insurance Administration overseeing these matters.