MD HB995

Establishes a Workgroup to Study the Rise in Adverse Decisions in the State Health Care System, comprising legislators, state health agency officials, and Governor-appointed representatives from hospitals, insurers, physicians, patient advocates, and health centers.

Requires the Workgroup to review existing adverse decision reporting requirements and analyze data including denial rates compared to total claims, health plan enrollment, and diagnostic/procedure information for each denial.

Directs the Workgroup to recommend standardized definitions for medical service categories, health settings, adverse decisions, and medical necessity, as well as standardized processes for categorizing denials and filing appeals.

Mandates a report with findings, recommendations, and proposed legislation to the Senate Finance Committee and House Health and Government Operations Committee by December 1, 2025.

Takes effect June 1, 2025 and automatically sunsets on June 30, 2026.