Health Occupations - Behavioral Health Care Providers - Use of Artificial Intelligence
HB0995 establishes a temporary Maryland workgroup to study the rise in “adverse decisions” in the state health care system. The workgroup is charged with reviewing existing reporting requirements across all health payers, examining how adverse decisions and prior authorization denials are tracked, and identifying the data needed to better understand trends in claim denials and related outcomes. It must also consider enrollee counts, diagnostic and procedure information, and other relevant data in order to assess the scope of the issue.
The bill directs the workgroup to develop recommendations for improving state reporting and standardizing key definitions and processes, including medical service categories, health settings, adverse decisions, medical necessity, grievance and complaint filing, and appeals. It must also propose strategies to reduce the number of adverse decisions and draft potential legislation to standardize reporting requirements across payers. The workgroup is required to report its findings and recommendations to the Senate Finance Committee and the House Health and Government Operations Committee by December 1, 2025, and the act sunsets on June 30, 2026.
The bill does not directly change substantive health insurance or Medicaid law; instead, it creates a temporary advisory workgroup within state government to study reporting and denial practices across insurers, managed care plans, hospitals, and other health care entities. Its practical effect is to bring together regulators, providers, insurers, patient advocates, and legislators to evaluate whether Maryland’s current adverse-decision reporting framework is adequate and to recommend future statutory or regulatory changes. The bill may influence later legislation affecting prior authorization, claims denials, utilization review, and standardized reporting across payers.
The available context suggests the bill was not the subject of recorded committee debate or vote opposition in the materials provided, and it ultimately became law. The overall tone of the measure is policy-oriented and problem-solving, focusing on data collection, transparency, and system-wide recommendations rather than immediate regulation. Because the bill was later withdrawn by sponsor in the legislative history context, the procedural posture appears somewhat mixed, but the enacted text reflects a consensus approach to studying a health care access and insurance oversight issue.
The main policy tension underlying the bill is between health care payers and patient/provider advocates over the frequency and handling of adverse decisions, including prior authorization denials and medical necessity determinations. Insurers and managed care organizations may be sensitive to standardized reporting requirements and definitions that could increase oversight or expose denial patterns, while hospitals, physicians, behavioral health providers, and patient advocates are likely to support greater transparency and clearer appeal processes. Another possible point of contention is the breadth of the workgroup’s mandate, which spans multiple sectors of the health system and could lead to differing views on how to define and measure adverse decisions.