"The Big Picture" Newsletter

May 2008 Issue

MARYLAND EDITION

Legislative Update

On April 7, the Maryland General Assembly adjourned the 2008 regular session.  Provider credentialing, contracting and PBM bills received the most significant consideration by the legislators. Among the bills sent to Governor Martin O’Malley for his consideration included:

H.B. 120/ S.B. 724 (PBM disclosure): The bill establishes what a PBM must disclose to a purchaser both before and after entering into a contract for PBM services.

H.B. 257/ S.B. 725 (PBM contracts): This bill requires a pharmacy benefits manager to disclose to a contracting pharmacy or pharmacist the terms, conditions, reimbursement rates, and procedures under the contract with the PBM.

H.B. 343/S.B. 723 (PBMs: Therapeutic Interchanges): The bill limits the circumstances in which a PBM may change one drug for another.

H.B. 419/S.B. 722 (PBMs: Registration): H.B. 419 establishes a staggered biennial registration requirement for PBMs with the Insurance Commissioner.

H.B. 578 (Amino Acid-Based Elemental Formula Mandate): The mandate provides that insurers, nonprofits, and HMOs that provide hospital, medical, or surgical benefits to individuals or groups in the State shall include, under the family member coverage, coverage for amino acid-based elemental formula.

H.B. 580/S.B. 720 (PBMs – P&T Committees): The bill establishes requirements for the membership and operations of a pharmacy and therapeutics committee of a PBM

H.B. 664/S.B. 444 (Corporate Income Tax): H.B. 664 provides for a streamlined version of the tax information to be provided by corporations to the Comptroller. Significantly, the bill provides that a corporate group does not include an insurer, as defined in § 1-101 of the Insurance Article.

H.B. 1219 (Health Care Provider Panels): The bill provides that a provider contract may not contain a provision that requires a provider, as a condition of participating in a non-HMO provider panel, to participate in an HMO provider panel or dental provider panel.

S.B. 595 (Provider Credentialing: Reimbursement): The bill requires a carrier to reimburse a nonparticipating provider who is a member of a group practice that is on the carrier’s provider panel at the participating provider rate in specified circumstances.

The list of defeated bills includes the following:
H.B. 69/S.B. 98	Prosthetic Parity Act (Mandate)
H.B. 236	Discretionary Clauses – Prohibition
H.B. 243/S.B. 726	Pharmacy Benefits Managers – Choice of Pharmacy
H.B. 701	Coverage for In Vitro Fertilization – Miscarriage
H.B. 737	Health Care Coverage – Personal Responsibility
H.B. 772	Substitution of Generic Drugs or Device Products
H.B. 1093	Health Care Coverage Fund – Tax on Health Insurance Premiums – Access to Health Care
H.B. 1125	Maryland Universal Health Care Plan
H.B. 1175	Provider Contracts – Conditions of Participation with Carriers
H.B. 1540	Health Care Reform Act of 2008
S.B. 65	Small Group Market – Coverage of Child Dependents
S.B. 611	Provider Contracts – Conditions of Participation with Carriers

                  
    

LOCAL SPOTLIGHT

Where We Are

60 Corporate Center
10490 Little Patuxent Parkway
Suite 400
Columbia, MD 21044

8403 Colesville Road
Suite 200
Silver Spring, MD 20910

Who to Contact

Gregg Prussing
410.884.2588
Gregg.Prussing@cigna.com

Julia Huggins
410.884.2510
Julia.Huggins@cigna.com