§ 15-144. Reports on coverage for mental health benefits and substance use disorder benefits; c...
West's Annotated Code of MarylandInsuranceEffective: April 13, 2021
Effective: April 13, 2021
MD Code, Insurance, § 15-144
§ 15-144. Reports on coverage for mental health benefits and substance use disorder benefits; compliance with the Mental Health Parity and Addiction Equity Act
(b) This section applies to a carrier that delivers or issues for delivery a health benefit plan in the State.
(c)(1) On or before March 1, 2022, and March 1, 2024, each carrier subject to this section shall:
(d)(1) A carrier subject to this section shall conduct a comparative analysis for the nonquantitative treatment limitations identified under subsection (c)(2)(ii) of this section as nonquantitative treatment limitations are:
(2) The comparative analysis of the nonquantitative treatment limitations identified under subsection (c)(2)(ii) of this section shall demonstrate that the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each nonquantitative treatment limitation to mental health benefits and substance use disorder benefits in each Parity Act classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each nonquantitative treatment limitation to medical and surgical benefits within the same Parity Act classification.
(e) In providing the analysis required under subsection (d) of this section, a carrier shall:
(5) identify the measures used to ensure comparable design and application of nonquantitative treatment limitations that are implemented by the carrier and any entity delegated by the carrier to manage mental health benefits, substance use disorder benefits, or medical/surgical benefits on behalf of the carrier;
(6) disclose the specific findings and conclusions reached by the carrier that indicate that the health benefit plan is in compliance with this section and the Parity Act and its implementing regulations, including 45 C.F.R. 146.136 and 29 C.F.R. 2590.712 and any other related federal regulations found in the Code of Federal Regulations; and
(iii) in connection with a member's request for group plan information and for purposes of filing an internal coverage or grievance matter and appeals, plan documents that contain information about processes, strategies, evidentiary standards, and any other factors used to apply a nonquantitative treatment limitation.
Report on mental health benefits, substance use disorder benefits, and medical/surgical benefits by Parity Act classification
(f) On or before March 1, 2022, and March 1, 2024, each carrier subject to this section shall submit a report for the health benefit plans identified under subsection (c)(1)(i) of this section to the Commissioner on the following data for the immediately preceding calendar year for mental health benefits, substance use disorder benefits, and medical/surgical benefits by Parity Act classification:
(1) the frequency, reported by number and rate, with which the health benefit plan received, approved, and denied prior authorization requests for mental health benefits, substance use disorder benefits, and medical and surgical benefits in each Parity Act classification during the immediately preceding calendar year; and
(g) The reports required under subsections (c) and (f) of this section shall:
(h)(1) A carrier submitting a report under subsections (c) and (f) of this section may submit a written request to the Commissioner that disclosure of specific information included in the report be denied under the Public Information Act and, if submitting a request, shall:
(i) The Commissioner shall:
(j) If the Commissioner finds that the carrier failed to submit a complete report required under subsection (c) or (f) of this section, the Commissioner may impose any penalty or take any action as authorized:
(k) If, as a result of the review required under subsection (i)(1) of this section, the Commissioner finds that the carrier failed to comply with the provisions of the Parity Act, and did not submit a compliance plan to adequately correct the noncompliance, the Commissioner may:
(l) In determining an appropriate penalty under subsection (j) or (k) of this section, the Commissioner shall consider the late filing of a report required under subsection (c) or (f) of this section and any parity violation to be a serious violation with a significantly deleterious effect on the public.
(m) On or before December 31, 2021, the Commissioner shall create:
Credits
Added by Acts 2020, c. 211, § 1, eff. Oct. 1, 2020; Acts 2020, c. 212, § 1, eff. Oct. 1, 2020. Amended by Acts 2021, c. 109, § 1, eff. April 13, 2021.
MD Code, Insurance, § 15-144, MD INSURANCE § 15-144
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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