Health Maintenance Organizations - Payments to Nonparticipating Providers - Reimbursement Rate

SB 437 requires health maintenance organizations (HMOs) in Maryland to pay non-contracted healthcare providers (like independent doctors or hospitals) higher reimbursement rates for services to HMO members. Specifically, it mandates that HMOs pay trauma physicians treating trauma patients at designated centers at least 140% of the Medicare rate for similar services, or the 2001 rate (whichever is higher), adjusted for inflation. For all other non-contracted providers, HMOs must pay at least 125% of the average rate paid to contracted providers in 2019, adjusted annually using the Medicare Economic Index. This bill directly affects nonparticipating healthcare providers who treat HMO enrollees but are not under formal contracts with the HMOs.