Appointed by Governor: Georgina D. Baez; Victoria W. Bayless; Gaetane D. Brunson; Patrick D. Carlson, Esq.; Vickye Hayter, D.N.P.; Heather V. Little; Daniel Martin; Adetoro Oriaifo, Pharm.D.; Zachary A. Peters; Jai Mitra Seunarine; Jagdeep Singh, M.D.; James J. York, M.D.; Ivan N. Zama, M.D.; one vacancy.
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; Douglas B. Jacobs, M.D., 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]](/msa/mdmanual/08conoff/attorney/images/i005966b.jpg)
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.
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 reviewing State adverse decision report requirements for all health payers in Maryland. It will 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 is to 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. Legislation to address the rise in such decisions, and standardize State reporting requirements regarding them for all payers is to be recommended by the Workgroup.
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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