EXECUTIVE ORDER 01.01.2025.28
Establishing All-Payer Total Cost of Care Growth and Primary Care Investment Targets in Maryland
A. Establishing all-payer total cost of care and primary care investment targets.
1. It is the policy of the State to address the rate of health care spending growth by establishing an all-payer total cost of care growth target annually starting in calendar year 2027 and each calendar year thereafter.
2. It is the policy of the State to address primary care investment by establishing an all-payer primary care investment target annually starting in calendar year 2027 and each calendar year thereafter, informed by the recommendations in the report required under Chapter 667 of the Acts of 2022 and codified at §19-108.4 of the Health-General Article.
3. These targets shall apply across all Maryland health care markets and populations.
B. The Multi-Agency Regulatory Working Group, established by the
Governor's Directive: Creation of Regulatory Working Group
, issued September 23, 2025, shall:
1. By no later than February 2026, initiate engagement with stakeholders to develop and advise on the development of the statewide all-payer total cost of care growth target;
2. By no later than February 2026, initiate engagement with the Maryland Health Care Commission's Primary Care Investment Workgroup and other stakeholders to develop and advise on development of a primary care investment target;
3. Update legislators on the development of the statewide all-payer total cost of care growth target and primary care investment target;
4. Assess data assets and data authorities, including those held by the State-designated health information exchange, and determine which data can be utilized to assess performance relative to a target;
5. Engage relevant regulated entities to assess data assets and furnish data required to assess performance relative to a target, within the limits of statutory authority;
6. Establish and engage in data collection, verification, analysis, and reporting processes;
7. Document a Statewide all-payer total cost of care growth target and primary care investment target methodology;
8. Develop, in consultation with stakeholders, policies and strategies to support attainment of the all-payer total cost of care growth targets and primary care investment targets.
9. Submit draft calendar year 2027—2030 all-payer total cost of care growth methodology and targets and primary care investment methodology and targets to the Governor no later than May 2026;
10. Submit final calendar year 2027—2030 all-payer total cost of care growth methodology and targets and primary care investment methodology and targets to the Governor no later than September 2026;
11. Starting in 2030 and applicable for all years thereafter, submit draft all-payer total cost of care growth targets and primary care investment targets to the Governor no later than May of calendar year preceding the target; and
12. Starting in 2030, submit final all-payer total cost of care growth targets and primary care investment targets to the Governor no later than September of the calendar year preceding the target.
C. General Provisions.
1. This Executive Order shall be implemented in a manner that is consistent with all applicable statutes and regulations. Nothing in this Executive Order shall operate to contravene any State or federal law or to affect the State's receipt of federal funding.
2. If any provision of this Executive Order or its application to any person, entity, or circumstance is held invalid by any court of competent jurisdiction, all other provisions or applications of the Executive Order shall remain in effect to the extent possible without the invalid provision or application. To achieve this purpose, the provisions of this Executive Order are severable.
Effective Date: December 19, 2025.
