Maryland payer mix, regulation & malpractice drivers
- Surprise billing protection: Robust state statute — state-level surprise billing protection beyond federal No Surprises Act
- Certificate of Need (CON) status: Extensive Certificate of Need — broad CON program covering hospitals, ASCs, imaging, and surgical capacity
- Medicaid expansion status: ACA Medicaid expanded — coverage to 138% federal poverty level
- Malpractice non-economic damages cap: Hard statutory non-economic damages cap — $920K non-economic cap as of 2024 (rises annually $15K under Md. Cts. & Jud. Proc. § 11-108)
- Hospital price transparency mandate: Robust state mandate — state-level price transparency beyond federal CMS Hospital Price Transparency Rule
- Dominant health insurance market structure: Multi-plan competitive — no single insurer holds dominant market share
Maryland medical board & physician licensing
- License status: Statewide license required
- License board: Maryland Board of Physicians (official site)
- Permit: Maryland Board of Physicians MD/DO license required; DEA Schedule II-V + Maryland Prescription Drug Monitoring Program (PDMP); hospital privileging at Johns Hopkins Health System / University of Maryland Medical System / MedStar Health / LifeBridge Health; CON required through Maryland Health Care Commission (MHCC); Maryland All-Payer Model unique state-wide hospital rate-setting authority through Health Services Cost Review Commission (HSCRC)
How medical care costs vary in Maryland
State-specific code or insurance rule: Maryland is the ONLY U.S. state operating a state-wide all-payer hospital rate-setting model — the Maryland All-Payer Model administered by the Health Services Cost Review Commission (HSCRC) since 1977 with a CMS-approved Total Cost of Care Model since 2019 — meaning Medicare, Medicaid, and commercial insurers ALL pay Maryland hospitals at the same rates established by HSCRC for the same services, and Maryland Cts. & Jud. Proc. § 11-108 caps medical malpractice non-economic damages at $920,000 for 2024 with a $15,000/year statutory increase (the floating cap increases annually), plus Maryland operates one of the more aggressive state surprise billing protection statutes through the Maryland Insurance Administration.
Cities in Maryland
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