The Source Roundup: August 2023 Edition
This month’s roundup of studies and reports highlights growing consolidation in health care as well as increasing costs of care. One report predicts higher medical costs in 2024—a trend that continued from the last two years. Another report highlights that policy efforts to reduce facility fees charged by hospitals are a potential avenue for controlling costs. Global capitation, in particular one value-based model utilized in Maryland, may help reduce the cost of specialty care delivery. Meanwhile, trends in the size of physician practices and recent M&A activity are indicators of growing consolidation. Lastly, our [...]
SB 678 (see companion bill HB 1151)
Requiring the Maryland Medical Assistance Program, the Maryland Children's Health Program, and certain insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for all services rendered to an enrollee by a licensed pharmacist within the pharmacist's lawful scope of practice, rather than only certain services, to the same extent as services rendered by any other health care practitioner.
HB 1151 (see companion bill SB 678)
Requiring the Maryland Medical Assistance Program, the Maryland Children's Health Program, and certain insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for all services rendered to an enrollee by a licensed pharmacist within the pharmacist's lawful scope of practice, rather than only certain services, to the same extent as services rendered by any other health care practitioner.
SB 725
Authorizing certain insurers, nonprofit health service plans, and health maintenance organizations to offer and provide certain products or services in conjunction with a policy at no charge or at a discounted price under certain circumstances; and prohibiting certain insurers, nonprofit health service plans, and health maintenance organizations from increasing a premium or denying a claim of a policyholder if the policyholder accepts, rejects, uses, or fails to use a certain product or service.
HB 1217 (see companion bill SB 805)
Requiring the Maryland Medical Assistance Program and certain insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations to provide coverage for biomarker testing that is supported by medical and scientific evidence; establishing requirements for deductibles, copayments, and coinsurance for biomarker testing; and requiring the Maryland Health Care Commission to report to certain committees of the General Assembly on the impact of providing biomarker testing.
SB 805 (see companion bill HB 1217)
Requiring the Maryland Medical Assistance Program and certain insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations to provide coverage for biomarker testing that is supported by medical and scientific evidence; establishing requirements for deductibles, copayments, and coinsurance for biomarker testing; and requiring the Maryland Health Care Commission to report to certain committees of the General Assembly on the impact of providing biomarker testing.
SB 64
Authorizing pharmacists to prescribe and dispense postexposure prophylaxis for HIV prevention to patients under certain circumstances; prohibiting managed care organizations, insurers, nonprofit health service plans, and health maintenance organizations from requiring prior authorization for preexposure prophylaxis for HIV prevention or step therapy or cost-sharing for preexposure prophylaxis for HIV prevention or postexposure prophylaxis for HIV prevention; etc.
SB 184 (see companion bill HB 376)
Prohibiting, except under certain circumstances, insurers, nonprofit health service plans, and health maintenance organizations that provide coverage for diagnostic and supplemental breast examinations from imposing a copayment, coinsurance, or deductible requirement for the examination; and requiring the Maryland Health Care Commission to study and report to the Governor and certain committees of the General Assembly by October 1, 2023, on the financial impact of eliminating cost-sharing for diagnostic image-guided biopsies for breast cancer.