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SB 776

Relating to predator management in drought-stricken regions; declaring an emergency.

2025 Regular Session Introduced by Bobby Levy and 1 co-sponsor

Creates a temporary workgroup to study rising adverse health care decisions in Maryland, standardize reporting, and deliver a Dec. 1, 2025 report with actions to reduce denials.

In committee upon adjournment.
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Bill Summary · SB 776

SB 776 — Workgroup to Study the Rise in Adverse Decisions in the State Health Care System

Status: Approved by the Governor — Chapter 671 (2025)

Purpose / Intent

Establishes a time‑limited workgroup to review the recent increase in "adverse decisions" (e.g., denials, prior authorization denials, grievance outcomes) across Maryland payers, to standardize reporting, identify causes, and recommend operational and legislative solutions to reduce adverse decisions and improve transparency and oversight.

Key provisions

  • Creates the "Workgroup to Study the Rise in Adverse Decisions in the State Health Care System."
  • Directs the Health Services Cost Review Commission (HSCRC) and the Maryland Insurance Administration (MIA) to jointly provide staff support (in consultation with the Maryland Hospital Association).
  • Requires a written report of findings and recommendations to the Senate Finance Committee and the House Health & Government Operations Committee by December 1, 2025.
  • Requires workgroup deliverables to include:
    • A review of existing state reporting requirements for adverse decisions across all payers and inclusion in the final report of specified data points (see “Duties”).
    • Recommendations for standardized definitions (medical service categories, health settings, adverse decisions, medical necessity).
    • Recommendations for standardized methods to categorize adverse decisions and prior authorization denials, standardized grievance/appeal reporting processes, and standardized clinical outcome reporting (e.g., NCQA, CMS star ratings).
    • Strategies and recommendations to reduce the number of adverse decisions.
    • Legislative recommendations to standardize reporting and address the rise in adverse decisions across payers.

Membership (summary)

The workgroup includes:
- One state senator (appointed by Senate President) and one delegate (appointed by the Speaker).
- State officials (or designees): Maryland Insurance Commissioner; Secretary of Health; Deputy Secretary of Maryland Medicaid Program; Executive Directors of HSCRC, Maryland Health Care Commission, and CRISP; Director of the Health Education & Advocacy Unit (Office of the Attorney General).
- Appointed stakeholder representatives (selected by legislative leaders / governor in enrolled version): Maryland Hospital Association; League of Life & Health Insurers; managed care plan; two hospital representatives (one large system, one community hospital); pharmacy services provider; behavioral health provider; commercial carrier; patient advocacy organization; one physician; MedChi representative; one federally qualified health center representative.
- Members elect a chair. Members are not paid but may be reimbursed for travel under State rules.

Duties / Required report contents

The final report must, at minimum, include:
- Number of adverse decisions relative to total claims processed (annual average).
- Number of enrollees per health plan.
- Diagnostic and procedure information tied to each adverse decision.
- Network adequacy metrics (provider ratios, geographic accessibility).
- Any other data informing reduction strategies.
Plus the standardization, strategy, and legislative recommendations described above.

Timeline and duration

  • Effective date: June 1, 2025.
  • Report due: December 1, 2025.
  • Sunset: The Act terminates June 30, 2026 (workgroup is temporary for ~13 months).

Fiscal impact

  • Statewide: Minimal. HSCRC and MIA can staff with existing resources.
  • HSCRC notes a one‑time FY2026 special fund expense of $50,000 for contractual services to support data collection/analysis and reporting.
  • No anticipated local government or small business fiscal impact.

Who is affected

  • State health agencies and regulators (HSCRC, MIA, Maryland Health Care Commission, Medicaid).
  • Health payers (commercial carriers, managed care plans), hospitals, providers (including behavioral health and pharmacy service providers), and patient advocacy organizations — particularly as reporting standards/legislative recommendations could impose new or changed reporting expectations.
  • Consumers indirectly, through anticipated recommendations intended to reduce inappropriate adverse decisions and improve transparency.

Procedural notes

  • The workgroup is statutorily required to coordinate across payers and existing reporting regimes and deliver a single set of findings and recommendations to the legislature by December 1, 2025.
  • The workgroup’s recommendations may form the basis for subsequent legislation to standardize adverse decision reporting and related oversight.

Compiled from official sources — confirm details with the bill’s official record.

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