Source: https://www.paritytrack.org/report/maryland/maryland-law/
Timestamp: 2020-08-04 11:05:38
Document Index: 534003797

Matched Legal Cases: ['§ 15', '§15', '§ 15', '§ 7', '§ 15', '§ 31', '§ 15', '§ 15', '§ 15', '§ 15']

Maryland Law | ParityTrack
Statutory Overview in Maryland
Primary Focus: General: Parity
Title/Description: MH/SUD Coverage Requirements for Short Term Limited Duration Insurance
Citation: Md. Insurance Code Ann. § 15-802
Summary: This Act amends the Annotated Code of Maryland §15-802 to include in the definition of a “health benefit plan” short term limited duration insurance for the purposes of coverage requirements for the diagnosis and treatment of MH and SUD.
Notes: Enacted through S28
Primary Focus: Compliance: Reporting Requirement; Enforcement; Medical Management Limitation
Title/Description: Coverage for Mental Health Benefits and Substance Use Disorder Benefits – Requirements and Reports
Summary: This Act amends section 15-802 by adding a new subsection to require insurers, nonprofit health service plans, or health maintenance organizations to use ASAM criteria for medical necessity and utilization management determinations for substance use disorder benefit claims.
Notes: Enacted through HB 599 / SB 631
Title/Description: Behavioral health care services provided at public school or school-based health center.
Citation: Md. INSURANCE Code Ann. § 15-510
Summary: No individual, group, or blanket insurance policy or contract issued or delivered in the State by an insurer, a nonprofit health service plan, or a health maintenance organization may deny a covered medically necessary behavioral health care service provided by a participating provider to a member who is a student solely on the basis that the service is provided at a public school or through a school-based health center under § 7-440 of the Education Article.
Notes: Amended by Md. HB 786.
Primary Focus: Mandated Benefits/ Parity – General
Title/Description: Benefits for treatment of mental illnesses, emotional disorders, and drug and alcohol misuse
Summary: A health benefit plan shall provide at least the following benefits for the diagnosis and treatment of a mental illness, emotional disorder, drug use disorder, or alcohol use disorder:
(1) inpatient benefits for services provided in a licensed or certified facility, including hospital inpatient and residential treatment center benefits; (2) partial hospitalization benefits; and (3) outpatient and intensive outpatient benefits, including all office visits, diagnostic evaluation, opioid treatment services, medication evaluation and management, and psychological and neuropsychological testing for diagnostic purposes. These benefits are required only if the health care professional finds that the mental illness, emotional disorder, drug misuse, or alcohol misuse is treatable, and if the treatment is medically necessary. The benefits shall be provided as one set of benefits covering mental illness, emotional disorders, drug abuse and alcohol abuse, must comply with federal law, and, for partial hospitalizations, may not be less than 60 days. While the benefits may be delivered under a managed care system, they may only be delivered as such if the benefits for physical illnesses covered under the health benefit plan are also delivered under a managed care system. Importantly, the processes, strategies, evidentiary standards, or other factors used to manage the benefits required under this section must be comparable as written and in operation to, and applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used to manage the benefits for physical illnesses covered under the health benefit plan. With regards to methadone maintenance treatment, an insurer, nonprofit health service plan, or health maintenance organization may not charge a copayment for methadone maintenance treatment that is greater than 50% of the daily cost for methadone maintenance treatment. Lastly, an entity that issues or delivers a health benefit plan must provide on its web site and annually in print to its insureds or members notice about the benefits required under this statute and the federal Mental Health Parity and Addiction Equity Act.
Notes: Amended by Md. HB 1127.
Sponsor: Del. Pena-Melnyk
Summary: This bill added a new section to the state insurance code that prohibits individual and group health plans from requiring prior authorization for medications used to treat substance use disorder that contain buprenorphine (Suboxone), Methadone, or naltrexone (Vivitrol).
Summary: This bill changed the section of the state insurance code about telehealth to specify that individual and group health plans must cover substance use disorder counseling services provided through telehealth.
HB 1127/SB 968
Sponsor: Del. Kelly and Sen. Klausmeier
Summary: This bill changes the state law regarding behavioral health insurance coverage so that the following types of services must be covered by individual and group insurance plans: Residential treatment, Intensive outpatient services, Diagnostic evaluation, Opioid treatment services, Medication evaluation and management
HB 1329/SB 967
Sponsor: Del. Bromwell and Sen. Klausmeier
Summary: Among many other things, this bill added a new section to the state insurance code that requires individual and group health plans to cover at least one opioid overdose reversal medication that does not require prior authorization.
Title/Description: Regulations to ensure parity of specialty mental health and substance use disorder services with federal acts.
Citation: Md. HEALTH-GENERAL Code Ann. § 15-103.6
Summary: The Maryland Department of Health is required to adopt regulations to ensure that the Maryland Medical Assistance Program is in compliance with the federal Mental Health Parity and Addiction Equity Act and the federal Patient Protection and Affordable Care Act. The regulations shall include standards regarding treatment limitations for specialty mental health and substance use disorder services compliant with federal law, and that relate to: (1) the scope of benefits for telehealth and residential treatment programs; (2) service notification and authorization requirements; (3) licensed specialty mental health or substance use disorder program billing for provided services; and
(4) reimbursement rates. The treatment limitations for specialty mental health and substance use disorder services must comply with the federal Mental Health Parity and Addiction Equity Act as well as the ACA. The operable processes, strategies, evidentiary standards, or other factors used in applying a treatment limitation to specialty mental health or substance use disorder services must be comparable to and no more restrictive than, and applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the treatment limitation to medical and surgical services.
Notes: Amended by Md. HB 1217. “Specialty mental health services” means any mental health services other than primary mental health services.
HB 1318/SB 929
Sponsor: Delegate Kelly and Senator Klausmeier
Summary: This bill targets network adequacy. Among other things, it requires health plans to submit a form called an access plan to the commissioner of insurance. This plan must include a description of the factors used by the health plan to build its provider network. One of those factors must be a demonstration that the criteria comply with the Federal Parity Law.
Citation: Md. INSURANCE Code Ann. § 31-116
Summary: The State “benchmark plan” contains the benefits required by the Affordable Care Act to be included as “essential health benefits.” In selecting the State benchmark plan, the Commissioner, in consultation with the Exchange, shall select a plan that complies with all requirements of the Maryland Health Benefit Exchange and the Affordable Care Act, the federal Mental Health Parity and Addiction Equity Act of 2008, and any other federal laws, regulations, policies, or guidance applicable to state benchmark plans and essential health benefits. For individual health benefit plans, the Commissioner shall require that the health benefit plans in the State benchmark plan include any mandated benefits that were required in individual health benefit plans before December 31, 2011, if the benefits are not included in the selected benchmark plan. If the selected state benchmark plan does not comply with any federal benefit requirement, the Commissioner is required to supplement the required benefits, to the extent permitted by federal law, with benefits similar to those chosen by the Maryland Health Care Reform Coordinating Council in 2012.
Notes: Amended by Md. SB 556.
HB 1233/SB 622
Sponsor: Sen. Middleton and Del. Bromwell
Summary: This bill gives the Maryland Health Care Commission authority to work with health providers to cancel out step-therapy or fail-first protocols required within insurance plans. The bill also requires insurers to describe a process that a care provider can use to supercede the recommendation of step therapies or fail first protocols by July 1, 2015. This is not explicitly about parity , but fail first protocols are often applied to behavioral health coverage more often than they are for other medical coverage.
HB 488/SB 84
Sponsor: Del. Pena-Melnyk and Sen. Benson
Summary: This bill created a joint committee of delegates and senators to monitor access to medically necessary behavioral health services in both the public system and for those covered by private insurance. The committee was to file a report on barriers and solutions.
Title/Description: Provisions for Marylanders transitioning between carriers and between carriers and State programs
Citation: Md. INSURANCE Code Ann. § 15-140
Summary: At the request of an enrollee or his or her guardian, or his or her health care provider, a receiving carrier or managed care organization shall allow a new enrollee to continue to receive health care services being rendered by a nonparticipating (out of network) provider at the time of the enrollee’s transition to the receiving health benefit plan or managed care organization for services related to mental health conditions and substance use conditions.
Notes: Amended by Md. HB 228.
Title/Description: Requirement for utilization review
Citation: Md. INSURANCE Code Ann. § 15-1001
Summary: When conducting utilization review for mental health and substance use benefits, ensure that the criteria and standards used are in compliance with the federal Mental Health Parity and Addiction Equity Act.
Notes: Amended by Md. SB 582.
Title/Description: Mental health and substance abuse benefits included for large employers
Citation: Md. INSURANCE Code Ann. § 15-1207
Summary: In establishing the Comprehensive Standard Health Benefit Plan, the Maryland Health Care Commission shall include mental health and substance abuse benefits for employers that qualify as “large employers.” Beginning January 1, 2014, this section applies only to grandfathered health plans as defined in Section 1251 of the ACA.
Notes: Amended by Md. HB 361.
HB 1216/SB 581
Sponsor: Del. Kelly and Sen. Kelley
Summary: This bill requires insurers to provide notice of behavioral health coverage required under the Federal Parity Law and the state parity law, and notify consumers to contact the Maryland Insurance Administration (MIA) for more information. The bill also requires insurers to post ‘release of information authorization’ forms on their websites and provide them by mail. Finally, the bill requires the MIA to provide information on its website about a consumer’s right to file a parity complaint with the State Insurance Commissioner and obtain information from insurers to support complaints (including health insurance policies or contracts).
HB 170/SB 183
Sponsor: Del. Kelly et al. and Sen. Middleton et al.
Summary: This bill requires insurers to disclose more information relevant to general appeals , grievance , and independent review organization (IRO) processes. This is not specific to parity , but these processes are all in play when parity-related violations occur. It also mandates that the commissioner of MIA seek advice from an IRO or a medical expert when a medical necessity complaint is filed. The law clarifies the definition of small employer to mean an employer with 2 to 50 employees. The Maryland Health Care Commission (MHCC) is also required to include federal mental health parity benefits for small employers who meet the definition of a large employer.
Sponsor: Chair, Finance Committee and Sen. Kelley et al.
Summary: This bill amended the Maryland state parity law to its current form by adding or modifying provisions to address partial hospitalization and some forms of non-quantitative treatment limitations (NQTLs) . Plans must cover partial hospitalization for behavioral health treatment at the same terms and conditions as they do for other medical treatment. However, if the plan offers less than 60 days of partial hospitalization coverage for other medical treatment, it must cover at least 60 days for behavioral health treatment. It also mandated that processes, strategies, evidentiary standards, or other factors that apply to behavioral health coverage must be similar and no more restrictive than the processes, strategies, evidentiary standards, or other factors that apply to other medical coverage.
Title/Description: Coverage for medically necessary residential crisis services
Citation: Md. INSURANCE Code Ann. § 15-840
Summary: Insurers and nonprofit health service plans that provide hospital, medical or surgical benefits to individuals or groups on an expense-incurred basis, and health maintenance organizations that provide those same benefits to individuals or groups under contracts must provide coverage for medically necessary residential crisis services. “Residential crisis services” means intensive mental health and support services that are: (1) provided to a child or an adult with a mental illness who is experiencing or is at risk of a psychiatric crisis that would impair the individual’s ability to function in the community; (2) designed to prevent a psychiatric inpatient admission, provide an alternative to psychiatric inpatient admission, or shorten the length of inpatient stay; (3) provided out of the individual’s residence on a short-term basis in a community-based residential setting; and
(4) provided by entities that are licensed by the Maryland Department of Health to provide residential crisis services.
Notes: Amended by Md. HB 549.
Maryland Insurance law requires large employer fully-insured plans,small employer fully-insured plans, and individual plans to provide coverage for behavioral health services under the “same terms and conditions” as other medical services with no exempted conditions.
This Section requires plans to comply with certain sections of the Federal Parity Law, including those that address financial requirements,quantitative treatment limitations, and non-quantitative treatment limitations (NQTLs).
This section requires that “Processes, strategies, evidentiary standards, or other factors used to determine coverage” for behavioral health coverage cannot be “applied more stringently” than they are for other medical coverage. Generally speaking that would mean NQTLs like prior authorization,medical necessity determinations, and other forms of utilization review.
Maryland law requires individual plans,small employer fully-insured plans, and large employer fully-insured plans to cover habilitative services for autism and a number of other developmental disorders through age 18.
This section requires plans to provide these services “in accordance with regulations adopted by the Commissioner” of the Maryland Insurance Administration.