MD
Maryland Senate Bill SB776

Maryland 2025 Regular Session

Maryland Senate Bill SB776 Compare Versions

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33 EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
44 [Brackets] indicate matter deleted from existing law.
55 Underlining indicates amendments to bill.
66 Strike out indicates matter stricken from the bill by amendment or deleted from the law by
77 amendment.
8- Italics indicate opposite chamber/conference committee amendments.
98 *sb0776*
109
1110 SENATE BILL 776
12-J5, J3 (5lr3286)
13-ENROLLED BILL
14-— Finance/Health and Government Operations —
15-Introduced by Senator Beidle
16-
17-Read and Examined by Proofreaders:
18-
19-_______________________________________________
20-Proofreader.
21-_______________________________________________
22-Proofreader.
23-
24-Sealed with the Great Seal and presented to the Governor, for his approval this
25-
26-_______ day of _______________ at _________________ _______ o’clock, ________M.
27-
28-______________________________________________
29-President.
11+J5, J3 5lr3286
12+ CF HB 995
13+By: Senator Beidle
14+Introduced and read first time: January 27, 2025
15+Assigned to: Finance
16+Committee Report: Favorable with amendments
17+Senate action: Adopted
18+Read second time: February 21, 2025
3019
3120 CHAPTER ______
3221
3322 AN ACT concerning 1
3423
3524 Workgroup to Study the Rise in Adverse Decisions in the State Health Care 2
3625 System – Establishment 3
3726
3827 FOR the purpose of establishing the Workgroup to Study the Rise in Adverse Decisions in 4
3928 the State Health Care System; and generally relating to the Workgroup to Study the 5
4029 Rise in Adverse Decisions in the State Health Care System. 6
4130
4231 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MA RYLAND, 7
4332 That: 8
4433
4534 (a) There is a Workgroup to Study the Rise in Adverse Decisions in the State 9
4635 Health Care System. 10
4736
4837 (b) The Workgroup consists of the following members: 11
49- 2 SENATE BILL 776
38+
39+ (1) one member of the Senate of Maryland, appointed by the President of 12
40+the Senate; 13
41+
42+ (2) one member of the House of Delegates, appointed by the Speaker of the 14
43+House; 15
44+
45+ (3) the Maryland Insurance Commissioner, or the Commissioner’s 16
46+designee; 17
47+
48+ (4) the Secretary of Health, or the Secretary’s designee; 18 2 SENATE BILL 776
5049
5150
52- (1) one member of the Senate of Maryland, appointed by the President of 1
53-the Senate; 2
5451
55- (2) one member of the House of Delegates, appointed by the Speaker of the 3
56-House; 4
52+ (5) (4) the Deputy Secretary of the Maryland Medicaid Program, or the Deputy 1
53+Secretary’s designee; 2
5754
58- (3) the Maryland Insurance Commissioner, or the Commissioner’s 5
59-designee; 6
55+ (6) (5) the Executive Director of the Health Services Cost Review Commission, 3
56+or the Executive Director’s designee; 4
6057
61- (4) the Secretary of Health, or the Secretary’s designee; 7
58+ (7) (6) the Executive Director of the Maryland Health Care Commission, or the 5
59+Executive Director’s designee; 6
6260
63- (5) (4) the Deputy Secretary of the Maryland Medicaid Program, or the Deputy 8
64-Secretary’s designee; 9
61+ (8) (7) the Executive Director of the Chesapeake Regional Information System 7
62+for our Patients, or the Executive Director’s designee; and 8
6563
66- (6) (5) the Executive Director of the Health Services Cost Review Commission, 10
67-or the Executive Director’s designee; 11
64+ (8) the Director of the Health Education and Advocacy Unit of the Office of 9
65+the Attorney General, or the Director’s designee; and 10
6866
69- (7) (6) the Executive Director of the Maryland Health Care Commission, or the 12
70-Executive Director’s designee; 13
67+ (9) the following members, appointed by the President of the Senate and 11
68+Speaker of the House Governor: 12
7169
72- (8) (7) the Executive Director of the Chesapeake Regional Information System 14
73-for our Patients, or the Executive Director’s designee; and 15
70+ (i) one representative of the Maryland Hospital Association; 13
7471
75- (8) the Director of the Health Education and Advocacy Unit of the Office of 16
76-the Attorney General, or the Director’s designee; and 17
72+ (ii) one representative of the League of Life and Health Insurers; 14
7773
78- (9) the following members, appointed by the President of the Senate and 18
79-Speaker of the House Governor: 19
74+ (iii) one representative of a managed care plan; 15
8075
81- (i) one representative of the Maryland Hospital Association; 20
76+ (iv) two representatives of Maryland hospitals , with one 16
77+representative from a large hospital system and one representative from a community 17
78+hospital; 18
8279
83- (ii) one representative of the League of Life and Health Insurers; 21
80+ (v) one pharmacy services provider; 19
8481
85- (iii) one representative of a managed care plan; 22
82+ (vi) one behavioral health provider; 20
8683
87- (iv) two representatives of Maryland hospitals , with one 23
88-representative from a large hospital system and one representative from a community 24
89-hospital; 25
84+ (vii) one representative of a commercial carrier; and 21
9085
91- (v) one pharmacy services provider; 26
86+ (viii) one representative of a patient advocacy organization; 22
9287
93- (vi) one behavioral health provider; 27
88+ (ix) one physician; 23
9489
95- (vii) one representative of a commercial carrier; and 28
90+ (x) one representative of MedChi; and 24
9691
97- (viii) one representative of a patient advocacy organization; 29
92+ (xi) one representative of a federally qualified health center. 25
93+
94+ (c) The Workgroup members shall elect the chair of the Workgroup. 26
9895 SENATE BILL 776 3
9996
10097
101- (ix) one physician two physicians; 1
98+ (d) The Health Services Cost Review Commission and the Maryland Insurance 1
99+Administration, jointly and in consultation with the Maryland Hospital Association, shall 2
100+provide staff for the Workgroup. 3
102101
103- (x) one representative of MedChi; and 2
102+ (e) A member of the Workgroup: 4
104103
105- (xi) one representative of a federally qualified health center. 3
104+ (1) may not receive compensation as a member of the Workgroup; but 5
106105
107- (c) The Workgroup members shall elect the chair of the Workgroup. 4
106+ (2) is entitled to reimbursement for expenses under the Standard State 6
107+Travel Regulations, as provided in the State budget. 7
108108
109- (d) The Health Services Cost Review Commission and the Maryland Insurance 5
110-Administration, jointly and in consultation with the Maryland Hospital Association, shall 6
111-provide staff for the Workgroup. 7
109+ (f) The Workgroup shall: 8
112110
113- (e) A member of the Workgroup: 8
111+ (1) review existing State adverse decision reporting requirements for all 9
112+health payers in the State and include in its final report: 10
114113
115- (1) may not receive compensation as a member of the Workgroup; but 9
114+ (i) the number of adverse decisions compared to the total number of 11
115+claims processed each year on average; 12
116116
117- (2) is entitled to reimbursement for expenses under the Standard State 10
118-Travel Regulations, as provided in the State budget. 11
117+ (ii) the number of enrollees in each health plan offered in the State; 13
119118
120- (f) The Workgroup shall: 12
119+ (iii) the diagnostic and procedure information for each adverse 14
120+decision; 15
121121
122- (1) review existing State adverse decision reporting requirements for all 13
123-health payers in the State and include in its final report: 14
122+ (iv) network adequacy, including provider ratios and geographic 16
123+accessibility; and 17
124124
125- (i) the number of adverse decisions compared to the total number of 15
126-claims processed each year on average; 16
125+ (v) any other data used to inform the Workgroup’s goal of reducing 18
126+adverse decisions; 19
127127
128- (ii) the number of enrollees in each health plan offered in the State; 17
128+ (2) make recommendations to improve State reporting on adverse 20
129+decisions, including recommendations regarding: 21
129130
130- (iii) the diagnostic and procedure information for each adverse 18
131-decision; 19
131+ (i) standardized definitions of: 22
132132
133- (iv) network adequacy, including provider ratios and geographic 20
134-accessibility; and 21
133+ 1. medical service categories; 23
135134
136- (v) any other data used to inform the Workgroup’s goal of reducing 22
137-adverse decisions; 23
135+ 2. health settings; 24
138136
139- (2) make recommendations to improve State reporting on adverse 24
140-decisions, including recommendations regarding: 25
137+ 3. adverse decisions; and 25
141138
142- (i) standardized definitions of: 26
139+ 4. medical necessity; 26
143140
144- 1. medical service categories; 27
145-
146- 2. health settings; 28
141+ (ii) a standardized method for categorizing adverse decisions and 27
142+prior authorization denials; 28
147143 4 SENATE BILL 776
148144
149145
150- 3. adverse decisions; and 1
146+ (iii) a standardized process for reporting grievances or filing 1
147+complaints and appealing adverse decisions; and 2
151148
152- 4. medical necessity; 2
149+ (iv) a standardized method for reporting clinical outcomes, including 3
150+National Committee for Quality Assurance ratings and Centers for Medicare and Medicaid 4
151+Services star ratings; 5
153152
154- (ii) a standardized method for categorizing adverse decisions and 3
155-prior authorization denials; 4
153+ (3) develop strategies for, and make recommendations to reduce, the 6
154+number of adverse decisions; and 7
156155
157- (iii) a standardized process for reporting grievances or filing 5
158-complaints and appealing adverse decisions; and 6
156+ (4) develop recommendations for legislation to address the rise in adverse 8
157+decisions and standardize State reporting requirements regarding adverse decisions across 9
158+all payers. 10
159159
160- (iv) a standardized method for reporting clinical outcomes, including 7
161-National Committee for Quality Assurance ratings and Centers for Medicare and Medicaid 8
162-Services star ratings; 9
160+ (g) On or before December 1, 2025, the Workgroup shall report its findings and 11
161+recommendations to the Senate Finance Committee and the House Health and 12
162+Government Operations Committee, in accordance with § 2–1257 of the State Government 13
163+Article. 14
163164
164- (3) develop strategies for, and make recommendations to reduce, the 10
165-number of adverse decisions; and 11
165+ SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 15
166+1, 2025. It shall remain effective for a period of 1 year and 1 month and, at the end of June 16
167+30, 2026, this Act, with no further action required by the General Assembly, shall be 17
168+abrogated and of no further force and effect. 18
166169
167- (4) develop recommendations for legislation to address the rise in adverse 12
168-decisions and standardize State reporting requirements regarding adverse decisions across 13
169-all payers. 14
170170
171- (g) On or before December 1, 2025, the Workgroup shall report its findings and 15
172-recommendations to the Senate Finance Committee and the House Health and 16
173-Government Operations Committee, in accordance with § 2–1257 of the State Government 17
174-Article. 18
175-
176- SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 19
177-1, 2025. It shall remain effective for a period of 1 year and 1 month and, at the end of June 20
178-30, 2026, this Act, with no further action required by the General Assembly, shall be 21
179-abrogated and of no further force and effect. 22
180171
181172
182173
183174 Approved:
184175 ________________________________________________________________________________
185176 Governor.
186177 ________________________________________________________________________________
187178 President of the Senate.
188179 ________________________________________________________________________________
189180 Speaker of the House of Delegates.