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

SB 475 prohibits Maryland health insurance carriers from requiring prior authorization, step therapy, or quantity limits for health care services included in a "two-sided incentive arrangement" between the carrier and eligible providers. Eligible providers include licensed physicians or groups of health care practitioners (such as accountable care organizations) who voluntarily participate in these value-based contracts. The bill also establishes specific rules for these arrangements, including limiting recoupment to 50% of excess costs and requiring quarterly cost disclosures to providers. This directly affects how insurers interact with participating providers for covered services under these specific contracts.