Health Insurance - Utilization Review - Exemption for Participation in Value-Based Care Arrangements

HB 659 prohibits health insurance carriers from requiring prior authorization, step therapy, or quantity limits for health care services provided by eligible providers participating in value-based care contracts. It directly affects insurers and healthcare providers (such as physicians or group practices) enrolled in two-sided incentive arrangements that tie payments to patient outcomes and cost efficiency. The bill amends Maryland’s insurance code to exempt these specific services from utilization review requirements while establishing contract terms for such arrangements, including limits on recoupment (max 50% of excess costs) and mandatory quarterly data sharing about patient costs. The policy change applies only to services covered under these defined value-based contracts, not all health care services.