Maryland Statutes

Md. Code, Health – Gen Section 15-141.2

Amends Maryland’s telehealth law by promoting coverage for MH/SUD services. This legislation expands telehealth services by requiring that private insurers, other carriers, and the Medicaid program reimburse providers for telehealth services provided via audio-only modalities. SB 3 prohibits the exclusions of behavioral health benefits solely because the service may be provided through telehealth.  By December 1, 2022, the Maryland Health Care Commission must submit a report on the impact of providing telehealth services in accordance with the bill’s requirements.

Enacted through SB 3/HB 123; Signed by the Governor on April 13, 2021

HB 455/SB 344.  Enacted under Article II, Section 17(c) of the Maryland Constitution – Chapter 211(Not codified in state statute as of August 1, 2020). For full text, click here.

The orientation of this new law is to promote parity compliance in conjunction with the federal parity law through a reporting and accountability system at the state level using the Maryland Insurance Commissioner.  Highlights include the following:

• Parity Reporting Requirements. A number of reporting requirements many of the activities associated with the new law (which tracks key elements of the Federal Parity Law).   Each health plan must submit a parity report in March 2022 and March 2024 demonstrating compliance with federal and Maryland parity requirements.
• Health Plan Sampling Requirements. Identification of:
  • The five largest health plans for each of three market segments (i.e. individual, small and large group markets).
  • As detailed more below, an overview of the processes, factors and sources used by health plans in how they make medical necessity and coverage determinations under each of the designated health insurance policies for three designated categories:  MH, SUD and medical/surgical benefits [technically referred to as quantitative treatment limitations (QTL’s) and non-quantitative treatment limitations  (NQTL’s)].
• Medical Necessity Disclosure Requirements. Identification of the processes used to develop and select medical necessity criteria for MH, SUD and medical/surgical benefits.
• NQTL Parity Comparability Analysis Requirements. Identification of:
  • Processes, strategies and evidentiary standards or other factors used to apply the medical necessity criteria to each MH/SUD classification, which shall be comparable to and applied no more stringently than to the same standards/factors applied to medical/surgical classifications.
  • The following factor elements: 1) the sources for the factors; 2) the factors that were considered but rejected; and 3) any factor weighting differentials.
  • The specific evidentiary standards used to define the factors, including the results of any audits, reviews or analyses performed.
  • The measures used to ensure comparable design and application of
• Denial and Appeal Tracking Requirements.
  • Identification of medical necessity criteria, reasons for a denial, and information related to the appeals and grievance process related to parity claims.
  • Frequency of approvals and denials for prior authorization requests by MH, SUD and medical/surgical benefits under each classification.
  • The number of claims submitted for the parity classifications and the number of denials for the previous calendar year.
  • Also must track and report on the reasons for the denials.
• Documentation & Follow-Up.
  • The health plan must attest to the veracity of the reported information.
  • The Insurance Commissioner:
    • Shall notify each health plan of noncompliance and include a follow-up remediation plan;
    • May levy fines/penalties and repayment decrees for parity violations;
    • Shall publish additional regulations on or before December 31, 2021; and
    • Shall submit a report to the MD Generally Assembly in December 2023 and December 2025.

March 1, 2022
Notes:  This new state parity law is based on a framework similar to but weaker than the Model State Parity Legislation developed by The Kennedy Forum and several other consumer advocacy groups. However, the new Maryland law implements a bi-annual reporting requirement whereas the Model State Parity law requires annual reporting.  Unlike the Model Law, the Maryland requirements require less data be collected, make less information available to the public and will sunset in 2026 if no further action is taken.  On a positive note, Maryland also has implemented a requirement that state Medicaid health plans follow a similar protocol by using URAC’s Parity Compliance Tool.

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.

Enacted through S28

Enacted through HB 599 / SB 631

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.

Amended by Md. HB 786.

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.

Amended by Md. HB 1127.

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.

Amended by Md. HB 1217. “Specialty mental health services” means any mental health services other than primary mental health services.

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.

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.

Amended by Md. SB 556.

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.

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.

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.

Amended by Md. HB 228.

Amended by Md. SB 582.

Amended by Md. HB 361.

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).

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.

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.