Health Maintenance Organizations - Payments to Nonparticipating Providers - Reimbursement Rate

SB 416 sets new minimum reimbursement rates that Maryland health maintenance organizations (HMOs) must pay to nonparticipating health care providers, such as doctors and hospitals not under contract with an HMO, for specific services. For trauma physicians treating trauma patients in designated trauma centers, HMOs must pay the greater of 140% of the Medicare rate (adjusted for inflation) or the 2001 rate (adjusted for inflation). For other services like routine office visits, HMOs must pay at least 125% of the rate they paid in 2019 (adjusted for inflation) or 140% of the Medicare rate from 2008 (adjusted for inflation), whichever is higher. This bill directly affects HMOs and nonparticipating providers by standardizing these minimum payment rates across Maryland.