Healthcare

Medical malpractice information disclosures; report. Requires insurers who issue medical malpractice liability insurance polices covering health care providers in the Commonwealth to disclose, for the preceding calendar year, information regarding (i) premiums; (ii) claims activity; (iii) claim payments and litigation costs; and (iv) insurer financial condition. The bill further requires every hospital or health system licensed in the Commonwealth that maintains self-insurance, captive insurance, risk retention arrangements, or other retained financial risk for medical malpractice liability to disclose information regarding (a) the numbers of physicians and health care providers covered under the malpractice liability program; (b) claims activity; (c) malpractice expenditures; and (d) the total malpractice liability expenditures for the reporting year. The bill further requires such insurers, hospitals, and health care systems to provide a list of verdicts during the reporting year in medical malpractice actions in which the jury verdict exceeded the medical malpractice limitation on recovery. The bill provides that such disclosures and information be submitted to the Chairs of the House and Senate Committees for Courts of Justice and to the ranking Delegate and Senator of the minority party serving on such Committees on or before September 1, 2026, for the 2025 calendar year and on or before March 31 of each year thereafter for the preceding calendar year.

Health insurance; prior authorization requests reviewed by physician. Requires a provider contract between a health insurance carrier and a provider to contain provisions requiring (i) any decision to deny a prior authorization request for drug benefits or health care services is made by a licensed physician who is (a) an expert in the treatment of the enrollee's medical condition that is the subject of the prior authorization request and (b) knowledgeable about the recommended health care service or treatment through recent or current actual clinical experience treating patients with the same or similar medical condition of the enrollee and (ii) if the carrier is questioning the medical necessity of the request, the carrier will provide the enrollee's physician an opportunity to discuss the medical necessity of the health care service with the physician who will be responsible for determining authorization of the health care service or drug benefit under review.