§ 15-144. Reports on coverage for mental health benefits and substance use disorder benefits; c...
West's Annotated Code of MarylandInsuranceEffective: April 25, 2024
Effective: April 25, 2024
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.
Comparative analysis of the nonquantitative treatment limitations; reports demonstrating compliance with the Parity Act
(c)(1) Each carrier subject to this section shall:
(iv) within 30 days after a written request, provide the comparative analysis for each nonquantitative treatment limitation and related in operation data analysis, if available and requested by a member in accordance with the Parity Act disclosure requirements or, for members with individual plans, in accordance with subsection (e)(7) of this section; and
(iii) subject to paragraph (4) of this subsection, a statement, signed by a corporate officer, attesting that, for each product identified under paragraph (2) of this subsection, the selected nonquantitative treatment limitations and the processes, strategies, evidentiary standards, or other factors used in designing and applying the selected nonquantitative treatment limitations to mental health benefits, substance use disorder benefits, and medical/surgical benefits are the same for all plans within the product, as written and in operation.
(4) If, for any plan within a product identified under paragraph (2) of this subsection, the processes, strategies, evidentiary standards, or other factors used in designing and applying the selected nonquantitative treatment limitations to mental health benefits, substance use disorder benefits, or medical/surgical benefits are different, as written or in operation, from the other plans within the product:
(d)(1) A carrier subject to this section shall conduct a comparative analysis for the nonquantitative treatment limitations selected under subsection (c)(5) of this section as nonquantitative treatment limitations are:
(i) demonstrate that the processes, strategies, evidentiary standards, or other factors used in designing and applying each selected 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 designing and applying each selected nonquantitative treatment limitation to medical/surgical benefits within the same Parity Act classification; and
(3) Regardless of whether it was used before the Parity Act was enacted and as requested by the Commission, a carrier shall perform and provide a comparative analysis for each process, strategy, evidentiary standard, or other factor used in designing and applying a selected nonquantitative treatment limitation used during a reporting period.
(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;
(iii) in connection with a member's request for individual or 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.
(f) The Commissioner shall:
(g) The reports required under this section shall:
(h)(1) A carrier submitting a report under 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:
(3) The Commissioner may require the carrier to establish specific quantitative thresholds for evidentiary standards and conduct a new comparative analysis for a nonquantitative treatment limitation if the Commissioner determines a carrier failed to provide a sufficient comparative analysis because the carrier did not:
(k) If, as a result of the review required under subsection (i)(1)(i) of this section, the Commissioner finds that the carrier failed to comply with the Parity Act, and did not submit a compliance plan to adequately correct the noncompliance, the Commissioner may:
(m) 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.
(n) 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; Acts 2024, c. 233, § 1, eff. April 1, 2024; Acts 2024, c. 234, § 1, eff. April 25, 2024.
MD Code, Insurance, § 15-144, MD INSURANCE § 15-144
Current through legislation effective through May 9, 2024, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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