EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb0995*
HOUSE BILL 995
J5, J3 5lr3283
CF SB 776
By: Delegate Pena–Melnyk Delegates Pena–Melnyk, Alston, Bagnall, Bhandari,
Chisholm, Cullison, Guzzone, Hill, Hutchinson, S. Johnson, Kaiser, Kerr,
Kipke, Lopez, Martinez, M. Morgan, Reilly, Rosenberg, Szeliga, Taveras,
White Holland, Woods, and Woorman
Introduced and read first time: January 31, 2025
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: February 22, 2025
CHAPTER ______
AN ACT concerning 1
Workgroup to Study the Rise in Adverse Decisions in the State Health Care 2
System – Establishment 3
FOR the purpose of establishing the Workgroup to Study the Rise in Adverse Decisions in 4
the State Health Care System; and generally relating to the Workgroup to Study the 5
Rise in Adverse Decisions in the State Health Care System. 6
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 7
That: 8
(a) There is a Workgroup to Study the Rise in Adverse Decisions in the State 9
Health Care System. 10
(b) The Workgroup consists of the following members: 11
(1) one member of the Senate of Maryland, appointed by the President of 12
the Senate; 13
(2) one member of the House of Delegates, appointed by the Speaker of the 14
House; 15
2 HOUSE BILL 995
(3) the Maryland Insurance Commissioner, or the Commissioner’s 1
designee; 2
(4) the Deputy Secretary of the Maryland Medicaid Program, or the Deputy 3
Secretary’s designee; 4
(5) the Executive Director of the Health Services Cost Review Commission, 5
or the Executive Director’s designee; 6
(6) the Executive Director of the Maryland Health Care Commission, or the 7
Executive Director’s designee; 8
(7) the Executive Director of the Chesapeake Regional Information System 9
for our Patients, or the Executive Director’s designee; and 10
(8) the Director of the Health Education and Advocacy Unit of the Office of 11
the Attorney General, or the Director’s designee; and 12
(8) (9) the following members, appointed by the President of the Senate and 13
Speaker of the House Governor: 14
(i) one representative of the Maryland Hospital Association; 15
(ii) one representative of the League of Life and Health Insurers; 16
(iii) one representative of a managed care plan; 17
(iv) two representatives of Maryland hospitals, with one 18
representative from a large hospital system and one representative from a community 19
hospital; 20
(v) one pharmacy services provider; 21
(vi) one behavioral health provider; 22
(vii) one representative of a commercial carrier; 23
(viii) one representative of a patient advocacy organization; 24
(ix) one physician; and 25
(x) one representative of MedChi; and 26
(xi) one representative of a federally qualified health center. 27
(c) The Workgroup members shall elect the chair of the Workgroup. 28
HOUSE BILL 995 3
(d) The Health Services Cost Review Commission and the Maryland Insurance 1
Administration, jointly and in consultation with the Maryland Hospital Association, shall 2
provide staff for the Workgroup. 3
(e) A member of the Workgroup: 4
(1) may not receive compensation as a member of the Workgroup; but 5
(2) is entitled to reimbursement for expenses under the Standard State 6
Travel Regulations, as provided in the State budget. 7
(f) The Workgroup shall: 8
(1) review existing State adverse decision reporting requirements for all 9
health payers in the State and include in its final report: 10
(i) the number of adverse decisions compared to the total number of 11
claims processed each year on average; 12
(ii) the number of enrollees in each health plan offered in the State; 13
(iii) the diagnostic and procedure information for each adverse 14
decision; and 15
(iv) any other data used to inform the Workgroup’s goal of reducing 16
adverse decisions; 17
(2) make recommendations to improve State reporting on adverse 18
decisions, including recommendations regarding: 19
(i) standardized definitions of: 20
1. medical service categories; 21
2. health settings; 22
3. adverse decisions; and 23
4. medical necessity; 24
(ii) a standardized method for categorizing adverse decisions and 25
prior authorization denials; and 26
(iii) a standardized process for reporting grievances or filing 27
complaints and appealing adverse decisions; 28
4 HOUSE BILL 995
(3) develop strategies for, and make recommendations to reduce, the 1
number of adverse decisions; and 2
(4) develop recommendations for legislation to address the rise in adverse 3
decisions and standardize State reporting requirements regarding adverse decisions across 4
all payers. 5
(g) On or before December 1, 2025, the Workgroup shall report its findings and 6
recommendations to the Senate Finance Committee and the House Health and 7
Government Operations Committee, in accordance with § 2–1257 of the State Government 8
Article. 9
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 10
1, 2025. It shall remain effective for a period of 1 year and 1 month and, at the end of June 11
30, 2026, this Act, with no further action required by the General Assembly, shall be 12
abrogated and of no further force and effect. 13
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.