MD
Maryland House Bill HB912

Maryland 2022 Regular Session

Maryland House Bill HB912 Compare Versions

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1- LAWRENCE J. HOGAN, JR., Governor Ch. 271
21
3-– 1 –
4-Chapter 271
5-(House Bill 912)
62
7-AN ACT concerning
3+EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4+ [Brackets] indicate matter deleted from existing law.
5+ Underlining indicates amendments to bill.
6+ Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7+amendment.
8+ *hb0912*
89
9-Health Insurance – Provider Panels – Coverage for Nonparticipation
10+HOUSE BILL 912
11+J2, J5 2lr1985
12+HB 1165/20 – HGO CF SB 707
13+By: Delegate Sample–Hughes Delegates Sample–Hughes, Bagnall, Belcastro,
14+Bhandari, Carr, Chisholm, Cullison, Hill, Johnson, Kaiser, Kelly, Kerr,
15+Kipke, Landis, R. Lewis, Morgan, Reilly, Rosenberg, Saab, Szeliga, and
16+K. Young
17+Introduced and read first time: February 7, 2022
18+Assigned to: Health and Government Operations
19+Committee Report: Favorable with amendments
20+House action: Adopted
21+Read second time: March 10, 2022
1022
11-FOR the purpose of requiring each carrier to inform members and beneficiaries of the right
12-procedure to request a referral to a specialist or nonphysician specialist who is not
13-part of the carrier’s provider panel; establishing a certain requirements requirement
14-on certain insurers, nonprofit health service plans, and health maintenance
15-organizations related to the coverage provision of certain mental health and
16-substance use disorder services provided to a member by a nonparticipating
17-provider; requiring the Consumer Education and Advocacy Program, in collaboration
18-with the Health Education and Advocacy Unit of the Office of the Attorney General,
19-to provide public education to inform consumers of certain rights procedures; and
20-generally relating to provider panels and coverage for nonparticipating providers.
23+CHAPTER ______
2124
22-BY repealing and reenacting, with amendments,
23- Article – Health – General
24- Section 19–710(p)
25- Annotated Code of Maryland
26- (2019 Replacement Volume and 2021 Supplement)
25+AN ACT concerning 1
2726
28-BY repealing and reenacting, with amendments,
29- Article – Insurance
30-Section 15–830
31- Annotated Code of Maryland
32- (2017 Replacement Volume and 2021 Supplement)
27+Health Insurance – Provider Panels – Coverage for Nonparticipation 2
3328
34- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
35-That the Laws of Maryland read as follows:
29+FOR the purpose of requiring each carrier to inform members and beneficiaries of the right 3
30+procedure to request a referral to a specialist or nonphysician specialist who is not 4
31+part of the carrier’s provider panel; establishing a certain requirements requirement 5
32+on certain insurers, nonprofit health service plans, and health maintenance 6
33+organizations related to the coverage provision of certain mental health and 7
34+substance use disorder services provided to a member by a nonparticipating 8
35+provider; requiring the Consumer Education and Advocacy Program, in collaboration 9
36+with the Health Education and Advocacy Unit of the Office of the Attorney General, 10
37+to provide public education to inform consumers of certain rights procedures; and 11
38+generally relating to provider panels and coverage for nonparticipating providers. 12
3639
37-Article – Health – General
40+BY repealing and reenacting, with amendments, 13
41+ Article – Health – General 14
42+ Section 19–710(p) 15
43+ Annotated Code of Maryland 16
44+ (2019 Replacement Volume and 2021 Supplement) 17
3845
39-19–710.
46+BY repealing and reenacting, with amendments, 18
47+ Article – Insurance 19
48+Section 15–830 20 2 HOUSE BILL 912
4049
41- (p) (1) Except as provided in paragraph (3) of this subsection, individual
42-enrollees and subscribers of health maintenance organizations issued certificates of
43-authority to operate in this State [shall] MAY not be liable to any health care provider for
44-any covered services provided to the enrollee or subscriber.
4550
46- (2) (i) A health care provider or any representative of a health care
47-provider may not collect or attempt to collect from any subscriber or enrollee any money
48-owed to the health care provider by a health maintenance organization issued a certificate
49-of authority to operate in this State. Ch. 271 2022 LAWS OF MARYLAND
51+ Annotated Code of Maryland 1
52+ (2017 Replacement Volume and 2021 Supplement) 2
5053
51-– 2 –
54+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 3
55+That the Laws of Maryland read as follows: 4
5256
53- (ii) A health care provider or any representative of a health care
54-provider may not maintain any action against any subscriber or enrollee to collect or
55-attempt to collect any money owed to the health care provider by a health maintenance
56-organization issued a certificate of authority to operate in this State.
57+Article – Health – General 5
5758
58- (3) Notwithstanding any other provision of this subsection, a health care
59-provider or representative of a health care provider may collect or attempt to collect from a
60-subscriber or enrollee:
59+19–710. 6
6160
62- (i) Any copayment or coinsurance sums owed by the subscriber or
63-enrollee to a health maintenance organization issued a certificate of authority to operate in
64-this State for covered services provided by the health care provider;
61+ (p) (1) Except as provided in paragraph (3) of this subsection, individual 7
62+enrollees and subscribers of health maintenance organizations issued certificates of 8
63+authority to operate in this State [shall] MAY not be liable to any health care provider for 9
64+any covered services provided to the enrollee or subscriber. 10
6565
66- (ii) If Medicare is the primary insurer and a health maintenance
67-organization is the secondary insurer, any amount up to the Medicare approved or limiting
68-amount, as specified under the Social Security Act, that is not owed to the health care
69-provider by Medicare or the health maintenance organization after coordination of benefits
70-has been completed, for Medicare covered services provided to the subscriber or enrollee by
71-the health care provider; or
66+ (2) (i) A health care provider or any representative of a health care 11
67+provider may not collect or attempt to collect from any subscriber or enrollee any money 12
68+owed to the health care provider by a health maintenance organization issued a certificate 13
69+of authority to operate in this State. 14
7270
73- (iii) Any payment or charges for services that are not covered
74-services.
71+ (ii) A health care provider or any representative of a health care 15
72+provider may not maintain any action against any subscriber or enrollee to collect or 16
73+attempt to collect any money owed to the health care provider by a health maintenance 17
74+organization issued a certificate of authority to operate in this State. 18
7575
76-Article – Insurance
76+ (3) Notwithstanding any other provision of this subsection, a health care 19
77+provider or representative of a health care provider may collect or attempt to collect from a 20
78+subscriber or enrollee: 21
7779
78-15–830.
80+ (i) Any copayment or coinsurance sums owed by the subscriber or 22
81+enrollee to a health maintenance organization issued a certificate of authority to operate in 23
82+this State for covered services provided by the health care provider; 24
7983
80- (a) (1) In this section the following words have the meanings indicated.
84+ (ii) If Medicare is the primary insurer and a health maintenance 25
85+organization is the secondary insurer, any amount up to the Medicare approved or limiting 26
86+amount, as specified under the Social Security Act, that is not owed to the health care 27
87+provider by Medicare or the health maintenance organization after coordination of benefits 28
88+has been completed, for Medicare covered services provided to the subscriber or enrollee by 29
89+the health care provider; or 30
8190
82- (2) “Carrier” means:
91+ (iii) Any payment or charges for services that are not covered 31
92+services. 32
8393
84- (i) an insurer that offers health insurance other than long–term
85-care insurance or disability insurance;
94+Article – Insurance 33
8695
87- (ii) a nonprofit health service plan;
96+15–830. 34
97+ HOUSE BILL 912 3
8898
89- (iii) a health maintenance organization;
9099
91- (iv) a dental plan organization; or
100+ (a) (1) In this section the following words have the meanings indicated. 1
92101
93- (v) except for a managed care organization as defined in Title 15,
94-Subtitle 1 of the Health – General Article, any other person that provides health benefit
95-plans subject to State regulation.
96- LAWRENCE J. HOGAN, JR., Governor Ch. 271
102+ (2) “Carrier” means: 2
97103
98-– 3 –
99- (3) (i) “Member” means an individual entitled to health care benefits
100-under a policy or plan issued or delivered in the State by a carrier.
104+ (i) an insurer that offers health insurance other than long–term 3
105+care insurance or disability insurance; 4
101106
102- (ii) “Member” includes a subscriber.
107+ (ii) a nonprofit health service plan; 5
103108
104- (4) “Nonphysician specialist” means a health care provider [who]:
109+ (iii) a health maintenance organization; 6
105110
106- (i) 1. WHO is not a physician;
111+ (iv) a dental plan organization; or 7
107112
108- [(ii)] 2. WHO is licensed or certified under the Health Occupations
109-Article; and
113+ (v) except for a managed care organization as defined in Title 15, 8
114+Subtitle 1 of the Health – General Article, any other person that provides health benefit 9
115+plans subject to State regulation. 10
110116
111- [(iii)] 3. WHO is certified or trained to treat or provide health care
112-services for a specified condition or disease in a manner that is within the scope of the
113-license or certification of the health care provider; OR
117+ (3) (i) “Member” means an individual entitled to health care benefits 11
118+under a policy or plan issued or delivered in the State by a carrier. 12
114119
115- (II) THAT IS LICENSED AS A BEHAVIORAL HEALTH PROGRAM
116-UNDER § 7.5–401 OF THE HEALTH – GENERAL ARTICLE.
120+ (ii) “Member” includes a subscriber. 13
117121
118- (5) (i) “Provider panel” means the providers that contract with a carrier
119-either directly or through a subcontracting entity to provide health care services to
120-enrollees of the carrier.
122+ (4) “Nonphysician specialist” means a health care provider [who]: 14
121123
122- (ii) “Provider panel” does not include an arrangement in which any
123-provider may participate solely by contracting with the carrier to provide health care
124-services at a discounted fee–for–service rate.
124+ (i) 1. WHO is not a physician; 15
125125
126- (6) “Specialist” means a physician who is certified or trained to practice in
127-a specified field of medicine and who is not designated as a primary care provider by the
128-carrier.
126+ [(ii)] 2. WHO is licensed or certified under the Health Occupations 16
127+Article; and 17
129128
130- (b) (1) Each carrier that does not allow direct access to specialists shall
131-establish and implement a procedure by which a member may receive a standing referral
132-to a specialist in accordance with this subsection.
129+ [(iii)] 3. WHO is certified or trained to treat or provide health care 18
130+services for a specified condition or disease in a manner that is within the scope of the 19
131+license or certification of the health care provider; OR 20
133132
134- (2) The procedure shall provide for a standing referral to a specialist if:
133+ (II) THAT IS LICENSED AS A BEHAVIORAL HEALTH PROGRAM 21
134+UNDER § 7.5–401 OF THE HEALTH – GENERAL ARTICLE. 22
135135
136- (i) the primary care physician of the member determines, in
137-consultation with the specialist, that the member needs continuing care from the specialist;
136+ (5) (i) “Provider panel” means the providers that contract with a carrier 23
137+either directly or through a subcontracting entity to provide health care services to 24
138+enrollees of the carrier. 25
138139
139- (ii) the member has a condition or disease that:
140+ (ii) “Provider panel” does not include an arrangement in which any 26
141+provider may participate solely by contracting with the carrier to provide health care 27
142+services at a discounted fee–for–service rate. 28
143+ 4 HOUSE BILL 912
140144
141- 1. is life threatening, degenerative, chronic, or disabling; and
142145
143- 2. requires specialized medical care; and
144- Ch. 271 2022 LAWS OF MARYLAND
146+ (6) “Specialist” means a physician who is certified or trained to practice in 1
147+a specified field of medicine and who is not designated as a primary care provider by the 2
148+carrier. 3
145149
146-– 4 –
147- (iii) the specialist:
150+ (b) (1) Each carrier that does not allow direct access to specialists shall 4
151+establish and implement a procedure by which a member may receive a standing referral 5
152+to a specialist in accordance with this subsection. 6
148153
149- 1. has expertise in treating the life –threatening,
150-degenerative, chronic, or disabling disease or condition; and
154+ (2) The procedure shall provide for a standing referral to a specialist if: 7
151155
152- 2. is part of the carrier’s provider panel.
156+ (i) the primary care physician of the member determines, in 8
157+consultation with the specialist, that the member needs continuing care from the specialist; 9
153158
154- (3) Except as provided in subsection (c) of this section, a standing referral
155-shall be made in accordance with a written treatment plan for a covered service developed
156-by:
159+ (ii) the member has a condition or disease that: 10
157160
158- (i) the primary care physician;
161+ 1. is life threatening, degenerative, chronic, or disabling; and 11
159162
160- (ii) the specialist; and
163+ 2. requires specialized medical care; and 12
161164
162- (iii) the member.
165+ (iii) the specialist: 13
163166
164- (4) A treatment plan may:
167+ 1. has expertise in treating the life –threatening, 14
168+degenerative, chronic, or disabling disease or condition; and 15
165169
166- (i) limit the number of visits to the specialist;
170+ 2. is part of the carrier’s provider panel. 16
167171
168- (ii) limit the period of time in which visits to the specialist are
169-authorized; and
172+ (3) Except as provided in subsection (c) of this section, a standing referral 17
173+shall be made in accordance with a written treatment plan for a covered service developed 18
174+by: 19
170175
171- (iii) require the specialist to communicate regularly with the primary
172-care physician regarding the treatment and health status of the member.
176+ (i) the primary care physician; 20
173177
174- (5) The procedure by which a member may receive a standing referral to a
175-specialist may not include a requirement that a member see a provider in addition to the
176-primary care physician before the standing referral is granted.
178+ (ii) the specialist; and 21
177179
178- (c) (1) Notwithstanding any other provision of this section, a member who is
179-pregnant shall receive a standing referral to an obstetrician in accordance with this
180-subsection.
180+ (iii) the member. 22
181181
182- (2) After the member who is pregnant receives a standing referral to an
183-obstetrician, the obstetrician is responsible for the primary management of the member’s
184-pregnancy, including the issuance of referrals in accordance with the carrier’s policies and
185-procedures, through the postpartum period.
182+ (4) A treatment plan may: 23
186183
187- (3) A written treatment plan may not be required when a standing referral
188-is to an obstetrician under this subsection.
184+ (i) limit the number of visits to the specialist; 24
189185
190- (d) (1) Each carrier shall establish and implement a procedure by which a
191-member may request a referral to a specialist or nonphysician specialist who is not part of
192-the carrier’s provider panel in accordance with this subsection. LAWRENCE J. HOGAN, JR., Governor Ch. 271
186+ (ii) limit the period of time in which visits to the specialist are 25
187+authorized; and 26
193188
194-– 5 –
189+ (iii) require the specialist to communicate regularly with the primary 27
190+care physician regarding the treatment and health status of the member. 28
191+ HOUSE BILL 912 5
195192
196- (2) The procedure shall provide for a referral to a specialist or nonphysician
197-specialist who is not part of the carrier’s provider panel if:
198193
199- (i) the member is diagnosed with a condition or disease that
200-requires specialized health care services or medical care; and
194+ (5) The procedure by which a member may receive a standing referral to a 1
195+specialist may not include a requirement that a member see a provider in addition to the 2
196+primary care physician before the standing referral is granted. 3
201197
202- (ii) 1. the carrier does not have in its provider panel a specialist
203-or nonphysician specialist with the professional training and expertise to treat or provide
204-health care services for the condition or disease; or
198+ (c) (1) Notwithstanding any other provision of this section, a member who is 4
199+pregnant shall receive a standing referral to an obstetrician in accordance with this 5
200+subsection. 6
205201
206- 2. the carrier cannot provide reasonable access to a specialist
207-or nonphysician specialist with the professional training and expertise to treat or provide
208-health care services for the condition or disease without unreasonable delay or travel.
202+ (2) After the member who is pregnant receives a standing referral to an 7
203+obstetrician, the obstetrician is responsible for the primary management of the member’s 8
204+pregnancy, including the issuance of referrals in accordance with the carrier’s policies and 9
205+procedures, through the postpartum period. 10
209206
210- (3) The procedure shall ensure that a request to obtain a referral to a
211-specialist or nonphysician specialist who is not part of the carrier’s provider panel is
212-addressed in a timely manner that is:
207+ (3) A written treatment plan may not be required when a standing referral 11
208+is to an obstetrician under this subsection. 12
213209
214- (i) appropriate for the member’s condition; and
210+ (d) (1) Each carrier shall establish and implement a procedure by which a 13
211+member may request a referral to a specialist or nonphysician specialist who is not part of 14
212+the carrier’s provider panel in accordance with this subsection. 15
215213
216- (ii) in accordance with the timeliness requirements for
217-determinations made by private review agents under § 15–10B–06 of this title.
214+ (2) The procedure shall provide for a referral to a specialist or nonphysician 16
215+specialist who is not part of the carrier’s provider panel if: 17
218216
219- (4) The procedure may not be used by a carrier as a substitute for
220-establishing and maintaining a sufficient provider network in accordance with § 15–112 of
221-this title.
217+ (i) the member is diagnosed with a condition or disease that 18
218+requires specialized health care services or medical care; and 19
222219
223- (5) Each carrier shall:
220+ (ii) 1. the carrier does not have in its provider panel a specialist 20
221+or nonphysician specialist with the professional training and expertise to treat or provide 21
222+health care services for the condition or disease; or 22
224223
225- (i) have a system in place that documents all requests to obtain a
226-referral to receive a covered service from a specialist or nonphysician specialist who is not
227-part of the carrier’s provider panel; [and]
224+ 2. the carrier cannot provide reasonable access to a specialist 23
225+or nonphysician specialist with the professional training and expertise to treat or provide 24
226+health care services for the condition or disease without unreasonable delay or travel. 25
228227
229- (II) INFORM MEMBERS AND BENEFICIARIES, IN PLAIN
230-LANGUAGE, OF THE RIGHT PROCEDURE TO REQUEST A REFERRA L UNDER
231-PARAGRAPH (1) OF THIS SUBSECTION IN PRINT AND ELECTRO NIC PLAN DOCUMENTS
232-AND ANY PROVIDER DIRECTORY ; AND
228+ (3) The procedure shall ensure that a request to obtain a referral to a 26
229+specialist or nonphysician specialist who is not part of the carrier’s provider panel is 27
230+addressed in a timely manner that is: 28
233231
234- [(ii)] (III) provide the information documented under item (i) of this
235-paragraph to the Commissioner on request.
232+ (i) appropriate for the member’s condition; and 29
236233
237- (e) (1) For EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS
238-SUBSECTION, FOR purposes of calculating any deductible, copayment amount, or
239-coinsurance payable by the member, a carrier shall treat services received in accordance Ch. 271 2022 LAWS OF MARYLAND
234+ (ii) in accordance with the timeliness requirements for 30
235+determinations made by private review agents under § 15–10B–06 of this title. 31
240236
241-– 6 –
242-with subsection (d) of this section as if the service was provided by a provider on the
243-carrier’s provider panel.
237+ (4) The procedure may not be used by a carrier as a substitute for 32
238+establishing and maintaining a sufficient provider network in accordance with § 15–112 of 33
239+this title. 34
240+ 6 HOUSE BILL 912
244241
245- (2) A CARRIER SHALL ENSURE THAT SERVICES RECEIV ED IN
246-ACCORDANCE WITH SUBS ECTION (D) OF THIS SECTION FOR MENTAL HEALTH OR
247-SUBSTANCE USE DISORD ERS ARE PROVIDED AT NO GREATER COST TO T HE COVERED
248-INDIVIDUAL THAN IF T HE COVERED BENEFIT W ERE PROVIDED BY A PR OVIDER ON
249-THE CARRIER’S PROVIDER PANEL .
250242
251- (2) ON REQUEST FOR AN IN –PERSON OR TELEHEALTH VISIT, IF THE
252-CARRIER’S PROVIDER PANEL HAS AN INSUFFI CIENT NUMBER OR TYPE OF
253-PARTICIPATING SPECIA LISTS OR NONPHYSICIA N SPECIALISTS WITH T HE EXPERTISE
254-TO PROVIDE THE COVER ED MENTAL HEALTH OR SUBSTANCE USE DISORD ER
255-SERVICES REQUIRED UN DER § 15–802 OR § 15–840 OF THIS SUBTITLE TO A MEMBER
256-WITHIN THE APPOINTMENT WAITING TIME OR TRAV EL DISTANCE STANDARD S
257-ESTABLISHED IN REGUL ATIONS, THE CARRIER SHALL CO VER THE SERVICES
258-PROVIDED BY A NONPAR TICIPATING PROVIDER AT NO GREATER COST T O THE
259-MEMBER THAN IF THE S ERVICES WERE PROVIDE D BY A PROVIDER ON T HE
260-CARRIER’S PROVIDER PANEL .
243+ (5) Each carrier shall: 1
261244
262- (3) EACH CARRIER SHALL US E THE REIMBURSEMENT RATE
263-ESTABLISHED UNDER PA RAGRAPH (4) OF THIS SUBSECTION T O:
245+ (i) have a system in place that documents all requests to obtain a 2
246+referral to receive a covered service from a specialist or nonphysician specialist who is not 3
247+part of the carrier’s provider panel; [and] 4
264248
265- (I) ENTER TIMELY SINGLE CASE AGREEMENTS ; AND
249+ (II) INFORM MEMBERS AND BENEFICIARIES , IN PLAIN 5
250+LANGUAGE, OF THE RIGHT PROCEDURE TO REQUEST A REFERRA L UNDER 6
251+PARAGRAPH (1) OF THIS SUBSECTION IN PRINT AND ELECTRO NIC PLAN DOCUMENTS 7
252+AND ANY PROVIDER DIRECTORY ; AND 8
266253
267- (II) PAY PROVIDERS .
254+ [(ii)] (III) provide the information documented under item (i) of this 9
255+paragraph to the Commissioner on request. 10
268256
269- (4) (I) SUBJECT TO SUBPARAGRA PH (II) OF THIS PARAGRAPH , AND
270-NOT LATER THAN JANUARY 1, 2023, THE MARYLAND HEALTH COMMISSION SHALL
271-ESTABLISH A REIMBURS EMENT FORMULA TO DET ERMINE THE REIMBURSE MENT
272-RATE FOR NONPARTICIP ATING PROVIDERS THAT DELIVER SERVICES UND ER
273-PARAGRAPH (2) OF THIS SUBSECTION .
257+ (e) (1) For EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS 11
258+SUBSECTION, FOR purposes of calculating any deductible, copayment amount, or 12
259+coinsurance payable by the member, a carrier shall treat services received in accordance 13
260+with subsection (d) of this section as if the service was provided by a provider on the 14
261+carrier’s provider panel. 15
274262
275- (II) THE MARYLAND HEALTH COMMISSION SHALL HOLD
276-PUBLIC MEETINGS WITH CARRIERS, MENTAL HEALTH AND SU BSTANCE USE
277-DISORDER PROVIDERS , CONSUMERS OF MENTAL HEALTH AND SUBSTANCE USE
278-DISORDER SERVICES , AND OTHER INTERESTED PARTIES TO DETERMINE THE
279-REIMBURSEMENT FORMUL A.
263+ (2) A CARRIER SHALL ENSURE THAT SERVICES RECEIVED IN 16
264+ACCORDANCE WITH SUBS ECTION (D) OF THIS SECTION FOR MENTAL HEALTH OR 17
265+SUBSTANCE USE DISORD ERS ARE PROVIDED AT NO GREATER COST TO T HE COVERED 18
266+INDIVIDUAL THAN IF T HE COVERED BENEFIT W ERE PROVIDED BY A PR OVIDER ON 19
267+THE CARRIER’S PROVIDER PANEL . 20
280268
281- (f) A decision by a carrier not to provide access to or coverage of treatment or
282-health care services by a specialist or nonphysician specialist in accordance with this
283-section constitutes an adverse decision as defined under Subtitle 10A of this title if the
284-decision is based on a finding that the proposed service is not medically necessary,
285-appropriate, or efficient. LAWRENCE J. HOGAN, JR., Governor Ch. 271
269+ (2) ON REQUEST FOR AN IN –PERSON OR TELEHEALTH VISIT, IF THE 21
270+CARRIER’S PROVIDER PANEL HAS AN INSUFFICIENT NUMB ER OR TYPE OF 22
271+PARTICIPATING SPECIA LISTS OR NONPHYSICIA N SPECIALISTS WITH T HE EXPERTISE 23
272+TO PROVIDE THE COVER ED MENTAL HEALTH OR SUBSTANCE USE DISORDER 24
273+SERVICES REQUIRED UN DER § 15–802 OR § 15–840 OF THIS SUBTITLE TO A MEMBER 25
274+WITHIN THE APPOINTME NT WAITING TIME OR T RAVEL DISTANCE STAND ARDS 26
275+ESTABLISHED IN REGUL ATIONS, THE CARRIER SHALL CO VER THE SERVICES 27
276+PROVIDED BY A NONPA RTICIPATING PROVIDER AT NO GREATER COST T O THE 28
277+MEMBER THAN IF THE S ERVICES WERE PROVIDE D BY A PROVIDER ON T HE 29
278+CARRIER’S PROVIDER PANEL . 30
286279
287-– 7 –
280+ (3) EACH CARRIER SHALL US E THE REIMBURSEMENT RATE 31
281+ESTABLISHED UNDER PA RAGRAPH (4) OF THIS SUBSECTION T O: 32
288282
289- (g) (1) Each carrier shall file with the Commissioner a copy of each of the
290-procedures required under this section, including:
283+ (I) ENTER TIMELY SINGLE CASE AGREEMENTS ; AND 33
291284
292- (i) steps the carrier requires of a member to request a referral;
285+ (II) PAY PROVIDERS . 34
286+ HOUSE BILL 912 7
293287
294- (ii) the carrier’s timeline for decisions; and
295288
296- (iii) the carrier’s grievance procedures for denials.
289+ (4) (I) SUBJECT TO SUBPARAGRA PH (II) OF THIS PARAGRAPH , AND 1
290+NOT LATER THAN JANUARY 1, 2023, THE MARYLAND HEALTH COMMISSION SHALL 2
291+ESTABLISH A REIMBURS EMENT FORMULA TO DET ERMINE THE REIMBURS EMENT 3
292+RATE FOR NONPARTICIP ATING PROVIDERS THAT DELIVER SERVICES UND ER 4
293+PARAGRAPH (2) OF THIS SUBSECTION . 5
297294
298- (2) Each carrier shall make a copy of each of the procedures filed under
299-paragraph (1) of this subsection available to its members:
295+ (II) THE MARYLAND HEALTH COMMISSION SHALL HOLD 6
296+PUBLIC MEETINGS WITH CARRIERS, MENTAL HEALTH AND SU BSTANCE USE 7
297+DISORDER PROVIDERS , CONSUMERS OF MENTAL HEALTH AND SU BSTANCE USE 8
298+DISORDER SERVICES , AND OTHER INTERESTED PARTIES TO DETERMINE THE 9
299+REIMBURSEMENT FORMUL A. 10
300300
301- (i) in the carrier’s online network directory required under §
302-15–112(n)(1) of this title; and
301+ (f) A decision by a carrier not to provide access to or coverage of treatment or 11
302+health care services by a specialist or nonphysician specialist in accordance with this 12
303+section constitutes an adverse decision as defined under Subtitle 10A of this title if the 13
304+decision is based on a finding that the proposed service is not medically necessary, 14
305+appropriate, or efficient. 15
303306
304- (ii) on request.
307+ (g) (1) Each carrier shall file with the Commissioner a copy of each of the 16
308+procedures required under this section, including: 17
305309
306- (H) THE CONSUMER EDUCATION AND ADVOCACY PROGRAM, ESTABLISHED
307-UNDER TITLE 2, SUBTITLE 3 OF THIS ARTICLE , IN COLLABORATION WIT H THE
308-HEALTH EDUCATION AND ADVOCACY UNIT OF THE OFFICE OF THE ATTORNEY
309-GENERAL, SHALL PROVIDE PUBLIC EDUCATION TO INFORM CONSUMERS OF THEIR
310-RIGHT PROCEDURES TO REQUEST A REFERRA L TO A SPECIALIST OR NONPHYSICIAN
311-SPECIALIST AS PROVID ED FOR IN THIS SECTI ON.
310+ (i) steps the carrier requires of a member to request a referral; 18
312311
313- (I) THIS SECTION MAY NOT BE CONSTRUED TO LIMI T THE PROVISIONS IN §
314-19–710(P) OF THE HEALTH – GENERAL ARTICLE.
312+ (ii) the carrier’s timeline for decisions; and 19
315313
316- SECTION 2. AND BE IT FURTHER ENACTED, That, on or before December 31,
317-2022, the health occupations boards that license, certify, or otherwise regulate mental
318-health and substance use disorder providers under the Health Occupations Article shall
319-report to the Senate Finance Committee and the House Health and Government
320-Operations Committee, in accordance with § 2–1257 of the State Government Article, on
321-the progress the boards have made to develop a process for providing information on mental
322-health and substance use disorder providers to carriers for the purpose of the carriers
323-reaching out to the providers regarding participation in the carriers’ provider panels.
314+ (iii) the carrier’s grievance procedures for denials. 20
324315
325- SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall apply to all
326-policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or
327-after January 1, 2023.
316+ (2) Each carrier shall make a copy of each of the procedures filed under 21
317+paragraph (1) of this subsection available to its members: 22
328318
329- SECTION 3. 4. AND BE IT FURTHER ENACTED, That this Act shall take effect
330-October 1, 2022. July 1, 2022. It shall remain effective for a period of 3 years and, at the
331-end of June 30, 2025, this Act, with no further action required by the General Assembly,
332-shall be abrogated and of no further force and effect.
333- Ch. 271 2022 LAWS OF MARYLAND
319+ (i) in the carrier’s online network directory required under § 23
320+15–112(n)(1) of this title; and 24
334321
335-– 8 –
336-Approved by the Governor, May 12, 2022.
322+ (ii) on request. 25
323+
324+ (H) THE CONSUMER EDUCATION AND ADVOCACY PROGRAM, ESTABLISHED 26
325+UNDER TITLE 2, SUBTITLE 3 OF THIS ARTICLE , IN COLLABORATION WIT H THE 27
326+HEALTH EDUCATION AND ADVOCACY UNIT OF THE OFFICE OF THE ATTORNEY 28
327+GENERAL, SHALL PROVIDE PUBLIC EDUCATION TO INFORM CONSUMERS OF TH EIR 29
328+RIGHT PROCEDURES TO REQUEST A REFERRA L TO A SPECIALIST OR NONPHYSICIAN 30
329+SPECIALIST AS PROVID ED FOR IN THIS SECTI ON. 31
330+
331+ (I) THIS SECTION MAY NOT BE CONSTRUED TO LIMI T THE PROVISIONS IN § 32
332+19–710(P) OF THE HEALTH – GENERAL ARTICLE. 33
333+ 8 HOUSE BILL 912
334+
335+
336+ SECTION 2. AND BE IT FURTHER ENACTED, That, on or before December 31, 1
337+2022, the health occupations boards that license, certify, or otherwise regulate mental 2
338+health and substance use disorder providers under the Health Occupations Article shall 3
339+report to the Senate Finance Committee and the House Health and Government 4
340+Operations Committee, in accordance with § 2–1257 of the State Government Article, on 5
341+the progress the boards have made to develop a process for providing information on mental 6
342+health and substance use disorder providers to carriers for the purpose of the carriers 7
343+reaching out to the providers regarding participation in the carriers’ provider panels. 8
344+
345+ SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall apply to all 9
346+policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 10
347+after January 1, 2023. 11
348+
349+ SECTION 3. 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 12
350+October 1, 2022. July 1, 2022. It shall remain effective for a period of 3 years and, at the 13
351+end of June 30, 2025, this Act, with no further action required by the General Assembly, 14
352+shall be abrogated and of no further force and effect. 15
353+
354+
355+
356+
357+Approved:
358+________________________________________________________________________________
359+ Governor.
360+________________________________________________________________________________
361+ Speaker of the House of Delegates.
362+________________________________________________________________________________
363+ President of the Senate.