WORKGROUP TO STUDY THE RISE IN ADVERSE DECISIONS IN THE STATE HEALTH CARE SYSTEM

Vacancy, Chair (chosen by Workgroup)

Appointed by Governor: not yet appointed

Appointed by Senate President: Pamela G. Beidle

Appointed by House Speaker: one vacancy

Ex officio:; Kimberly S. Cammarata, Director, Health Education & Advocacy Unit, Office of Attorney General; Perrie T. Briskin, Deputy Secretary for Health Care Financing & Medicaid; Michael J. (Ben) Steffen, Executive Director, Maryland Health Care Commission; Jonathan N. Kromm, Ph.D., Executive Director, State Health Services Cost Review Commission; Marie L. Grant, J.D., Maryland Insurance Commissioner; Craig Behm, Executive Director, Chesapeake Regional Information System for our Patients (CRISP).

Staff: Jonathan N. Kromm, Ph.D.
c/o State Health Services Cost Review Commission
Reisterstown Road Plaza, 4160 Patterson Ave., Baltimore, MD 21215
(410) 764-2605
e-mail: jon.kromm@maryland.gov

[photo, St. Paul Plaza, 200 St. Paul Place, Baltimore, Maryland] Staff: David J. Cooney
c/o Life & Health Division, Maryland Insurance Administration
St. Paul Plaza, 200 St. Paul Place, Suite 2700, Baltimore, MD 21202 - 2272
(410) 468-2215
e-mail: david.cooney@maryland.gov


St. Paul Plaza, 200 St. Paul Place, Baltimore, Maryland, January 2001. Photo by Diane F. Evartt.

Report to Governor, Senate Finance Committee, & House Health & Government Operations Committee due Dec. 1, 2025 (Chapters 671 & 672, Acts of 2025).
In June 2025, the Workgroup to Study the Rise in Adverse Decisions in the State Health Care System was authorized by the General Assembly (Chapters 671 & 672, Acts of 2025). 

Adverse decisions in the State health care system refers most commonly to determinations made by an insurance carrier or provider that a healthcare service is not medically necessary, appropriate, or efficient, and therefore will not be covered by insurance.

The Workgroup is to review State adverse decision reporting requirements for all health payers in Maryland, and report: the number of adverse decisions compared to the total number of claims processed each year on average; the number of enrollees in each health plan offered in the State; the diagnostic and procedure information for each adverse decision; and any other useful data. To improve State reporting on adverse decisions, the Workgroup will recommend a standardized method for categorizing adverse decisions and prior authorization denials; and a standardized process for reporting grievances or filing complaints and appeals. Further, the Workgroup will develop strategies for, and make recommendations to reduce, the number of adverse decisions. Moreover, it will recommend legislation to address the rise in such decisions; and standardize State reporting requirements regarding them for all payers.

Twenty members constitute the Workgroup. Of these, the Governor appoints twelve members, and the Senate President and House Speaker each appoint one. Six members serve ex officio. The Workgroup names the Chair.

Authorization for the Workgroup ends June 30, 2026.

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