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*hb0995*
HOUSE BILL 995
J5, J3 (5lr3283)
ENROLLED BILL
— Health and Government Operations/Finance —
Introduced 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
Read and Examined by Proofreaders:
_______________________________________________
Proofreader.
_______________________________________________
Proofreader.
Sealed with the Great Seal and presented to the Governor, for his approval this
_______ day of _______________ at ________________________ o’clock, ________M .
______________________________________________
Speaker.
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 2 HOUSE BILL 995
(b) The Workgroup consists of the following members: 1
(1) one member of the Senate of Maryland, appointed by the President of 2
the Senate; 3
(2) one member of the House of Delegates, appointed by the Speaker of the 4
House; 5
(3) the Maryland Insurance Commissioner, or the Commissioner’s 6
designee; 7
(4) the Deputy Secretary of the Maryland Medicaid Program, or the Deputy 8
Secretary’s designee; 9
(5) the Executive Director of the Health Services Cost Review Commission, 10
or the Executive Director’s designee; 11
(6) the Executive Director of the Maryland Health Care Commission, or the 12
Executive Director’s designee; 13
(7) the Executive Director of the Chesapeake Regional Information System 14
for our Patients, or the Executive Director’s designee; and 15
(8) the Director of the Health Education and Advocacy Unit of the Office of 16
the Attorney General, or the Director’s designee; and 17
(8) (9) the following members, appointed by the President of the Senate and 18
Speaker of the House Governor: 19
(i) one representative of the Maryland Hospital Association; 20
(ii) one representative of the League of Life and Health Insurers; 21
(iii) one representative of a managed care plan; 22
(iv) two representatives of Maryland hospitals, with one 23
representative from a large hospital system and one representative from a community 24
hospital; 25
(v) one pharmacy services provider; 26
(vi) one behavioral health provider; 27
(vii) one representative of a commercial carrier; 28
(viii) one representative of a patient advocacy organization; 29 HOUSE BILL 995 3
(ix) one physician two physicians; and 1
(x) one representative of MedChi; and 2
(xi) one representative of a federally qualified health center. 3
(c) The Workgroup members shall elect the chair of the Workgroup. 4
(d) The Health Services Cost Review Commission and the Maryland Insurance 5
Administration, jointly and in consultation with the Maryland Hospital Association, shall 6
provide staff for the Workgroup. 7
(e) A member of the Workgroup: 8
(1) may not receive compensation as a member of the Workgroup; but 9
(2) is entitled to reimbursement for expenses under the Standard State 10
Travel Regulations, as provided in the State budget. 11
(f) The Workgroup shall: 12
(1) review existing State adverse decision reporting requirements for all 13
health payers in the State and include in its final report: 14
(i) the number of adverse decisions compared to the total number of 15
claims processed each year on average; 16
(ii) the number of enrollees in each health plan offered in the State; 17
(iii) the diagnostic and procedure information for each adverse 18
decision; and 19
(iv) any other data used to inform the Workgroup’s goal of reducing 20
adverse decisions; 21
(2) make recommendations to improve State reporting on adverse 22
decisions, including recommendations regarding: 23
(i) standardized definitions of: 24
1. medical service categories; 25
2. health settings; 26
3. adverse decisions; and 27
4 HOUSE BILL 995
4. medical necessity; 1
(ii) a standardized method for categorizing adverse decisions and 2
prior authorization denials; and 3
(iii) a standardized process for reporting grievances or filing 4
complaints and appealing adverse decisions; 5
(3) develop strategies for, and make recommendations to reduce, the 6
number of adverse decisions; and 7
(4) develop recommendations for legislation to address the rise in adverse 8
decisions and standardize State reporting requirements regarding adverse decisions across 9
all payers. 10
(g) On or before December 1, 2025, the Workgroup shall report its findings and 11
recommendations to the Senate Finance Committee and the House Health and 12
Government Operations Committee, in accordance with § 2–1257 of the State Government 13
Article. 14
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 15
1, 2025. It shall remain effective for a period of 1 year and 1 month and, at the end of June 16
30, 2026, this Act, with no further action required by the General Assembly, shall be 17
abrogated and of no further force and effect. 18
Approved:
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Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
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President of the Senate.