MD
Maryland Senate Bill SB707

Maryland 2022 Regular Session

Maryland Senate Bill SB707 Compare Versions

OldNewDifferences
1- LAWRENCE J. HOGAN, JR., Governor Ch. 272
21
3-– 1 –
4-Chapter 272
5-(Senate Bill 707)
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+ *sb0707*
89
9-Health Insurance – Provider Panels – Coverage for Nonparticipation
10+SENATE BILL 707
11+J2, J5 2lr1839
12+SB 484/20 – FIN CF HB 912
13+By: Senator Klausmeier
14+Introduced and read first time: February 4, 2022
15+Assigned to: Finance
16+Committee Report: Favorable with amendments
17+Senate action: Adopted
18+Read second time: March 7, 2022
1019
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.
20+CHAPTER ______
2121
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)
22+AN ACT concerning 1
2723
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)
24+Health Insurance – Provider Panels – Coverage for Nonparticipation 2
3325
34- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
35-That the Laws of Maryland read as follows:
26+FOR the purpose of requiring each carrier to inform members and beneficiaries of the right 3
27+procedure to request a referral to a specialist or nonphysician specialist who is not 4
28+part of the carrier’s provider panel; establishing a certain requirements requirement 5
29+on certain insurers, nonprofit health service plans, and health maintenance 6
30+organizations related to the coverage provision of certain mental health and 7
31+substance use disorder services provided to a member by a nonparticipating 8
32+provider; requiring the Consumer Education and Advocacy Program, in collaboration 9
33+with the Health Education and Advocacy Unit of the Office of the Attorney General, 10
34+to provide public education to inform consumers of certain rights procedures; and 11
35+generally relating to provider panels and coverage for nonparticipating providers. 12
3636
37-Article – Health – General
37+BY repealing and reenacting, with amendments, 13
38+ Article – Health – General 14
39+ Section 19–710(p) 15
40+ Annotated Code of Maryland 16
41+ (2019 Replacement Volume and 2021 Supplement) 17
3842
39-19–710.
43+BY repealing and reenacting, with amendments, 18
44+ Article – Insurance 19
45+Section 15–830 20
46+ Annotated Code of Maryland 21
47+ (2017 Replacement Volume and 2021 Supplement) 22
48+ 2 SENATE BILL 707
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. 272 2022 LAWS OF MARYLAND
51+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 1
52+That the Laws of Maryland read as follows: 2
5053
51-– 2 –
54+Article – Health – General 3
5255
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.
56+19–710. 4
5757
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:
58+ (p) (1) Except as provided in paragraph (3) of this subsection, individual 5
59+enrollees and subscribers of health maintenance organizations issued certificates of 6
60+authority to operate in this State [shall] MAY not be liable to any health care provider for 7
61+any covered services provided to the enrollee or subscriber. 8
6162
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;
63+ (2) (i) A health care provider or any representative of a health care 9
64+provider may not collect or attempt to collect from any subscriber or enrollee any money 10
65+owed to the health care provider by a health maintenance organization issued a certificate 11
66+of authority to operate in this State. 12
6567
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
68+ (ii) A health care provider or any representative of a health care 13
69+provider may not maintain any action against any subscriber or enrollee to collect or 14
70+attempt to collect any money owed to the health care provider by a health maintenance 15
71+organization issued a certificate of authority to operate in this State. 16
7272
73- (iii) Any payment or charges for services that are not covered
74-services.
73+ (3) Notwithstanding any other provision of this subsection, a health care 17
74+provider or representative of a health care provider may collect or attempt to collect from a 18
75+subscriber or enrollee: 19
7576
76-Article – Insurance
77+ (i) Any copayment or coinsurance sums owed by the subscriber or 20
78+enrollee to a health maintenance organization issued a certificate of authority to operate in 21
79+this State for covered services provided by the health care provider; 22
7780
78-15–830.
81+ (ii) If Medicare is the primary insurer and a health maintenance 23
82+organization is the secondary insurer, any amount up to the Medicare approved or limiting 24
83+amount, as specified under the Social Security Act, that is not owed to the health care 25
84+provider by Medicare or the health maintenance organization after coordination of benefits 26
85+has been completed, for Medicare covered services provided to the subscriber or enrollee by 27
86+the health care provider; or 28
7987
80- (a) (1) In this section the following words have the meanings indicated.
88+ (iii) Any payment or charges for services that are not covered 29
89+services. 30
8190
82- (2) “Carrier” means:
91+Article – Insurance 31
8392
84- (i) an insurer that offers health insurance other than long–term
85-care insurance or disability insurance;
93+15–830. 32
8694
87- (ii) a nonprofit health service plan;
95+ (a) (1) In this section the following words have the meanings indicated. 33
8896
89- (iii) a health maintenance organization;
97+ (2) “Carrier” means: 34 SENATE BILL 707 3
9098
91- (iv) a dental plan organization; or
9299
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. 272
97100
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.
101+ (i) an insurer that offers health insurance other than long–term 1
102+care insurance or disability insurance; 2
101103
102- (ii) “Member” includes a subscriber.
104+ (ii) a nonprofit health service plan; 3
103105
104- (4) “Nonphysician specialist” means a health care provider [who]:
106+ (iii) a health maintenance organization; 4
105107
106- (i) 1. WHO is not a physician;
108+ (iv) a dental plan organization; or 5
107109
108- [(ii)] 2. WHO is licensed or certified under the Health Occupations
109-Article; and
110+ (v) except for a managed care organization as defined in Title 15, 6
111+Subtitle 1 of the Health – General Article, any other person that provides health benefit 7
112+plans subject to State regulation. 8
110113
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
114+ (3) (i) “Member” means an individual entitled to health care benefits 9
115+under a policy or plan issued or delivered in the State by a carrier. 10
114116
115- (II) THAT IS LICENSED AS A BEHAVIORAL HEALTH PROGRAM
116-UNDER § 7.5–401 OF THE HEALTH – GENERAL ARTICLE.
117+ (ii) “Member” includes a subscriber. 11
117118
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.
119+ (4) “Nonphysician specialist” means a health care provider [who]: 12
121120
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.
121+ (i) 1. WHO is not a physician; 13
125122
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.
123+ [(ii)] 2. WHO is licensed or certified under the Health Occupations 14
124+Article; and 15
129125
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.
126+ [(iii)] 3. WHO is certified or trained to treat or provide health care 16
127+services for a specified condition or disease in a manner that is within the scope of the 17
128+license or certification of the health care provider; OR 18
133129
134- (2) The procedure shall provide for a standing referral to a specialist if:
130+ (II) THAT IS LICENSED AS A BEHAVIORAL HEALTH PROGRAM 19
131+UNDER § 7.5–401 OF THE HEALTH – GENERAL ARTICLE. 20
135132
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;
133+ (5) (i) “Provider panel” means the providers that contract with a carrier 21
134+either directly or through a subcontracting entity to provide health care services to 22
135+enrollees of the carrier. 23
138136
139- (ii) the member has a condition or disease that:
137+ (ii) “Provider panel” does not include an arrangement in which any 24
138+provider may participate solely by contracting with the carrier to provide health care 25
139+services at a discounted fee–for–service rate. 26
140140
141- 1. is life threatening, degenerative, chronic, or disabling; and
141+ (6) “Specialist” means a physician who is certified or trained to practice in 27
142+a specified field of medicine and who is not designated as a primary care provider by the 28
143+carrier. 29
144+ 4 SENATE BILL 707
142145
143- 2. requires specialized medical care; and
144- Ch. 272 2022 LAWS OF MARYLAND
145146
146-– 4 –
147- (iii) the specialist:
147+ (b) (1) Each carrier that does not allow direct access to specialists shall 1
148+establish and implement a procedure by which a member may receive a standing referral 2
149+to a specialist in accordance with this subsection. 3
148150
149- 1. has expertise in treating the life –threatening,
150-degenerative, chronic, or disabling disease or condition; and
151+ (2) The procedure shall provide for a standing referral to a specialist if: 4
151152
152- 2. is part of the carrier’s provider panel.
153+ (i) the primary care physician of the member dete rmines, in 5
154+consultation with the specialist, that the member needs continuing care from the specialist; 6
153155
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:
156+ (ii) the member has a condition or disease that: 7
157157
158- (i) the primary care physician;
158+ 1. is life threatening, degenerative, chronic, or disabling; and 8
159159
160- (ii) the specialist; and
160+ 2. requires specialized medical care; and 9
161161
162- (iii) the member.
162+ (iii) the specialist: 10
163163
164- (4) A treatment plan may:
164+ 1. has expertise in treating the life –threatening, 11
165+degenerative, chronic, or disabling disease or condition; and 12
165166
166- (i) limit the number of visits to the specialist;
167+ 2. is part of the carrier’s provider panel. 13
167168
168- (ii) limit the period of time in which visits to the specialist are
169-authorized; and
169+ (3) Except as provided in subsection (c) of this section, a standing referral 14
170+shall be made in accordance with a written treatment plan for a covered service developed 15
171+by: 16
170172
171- (iii) require the specialist to communicate regularly with the primary
172-care physician regarding the treatment and health status of the member.
173+ (i) the primary care physician; 17
173174
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.
175+ (ii) the specialist; and 18
177176
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.
177+ (iii) the member. 19
181178
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.
179+ (4) A treatment plan may: 20
186180
187- (3) A written treatment plan may not be required when a standing referral
188-is to an obstetrician under this subsection.
181+ (i) limit the number of visits to the specialist; 21
189182
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. 272
183+ (ii) limit the period of time in which visits to the specialist are 22
184+authorized; and 23
193185
194-– 5 –
186+ (iii) require the specialist to communicate regularly with the primary 24
187+care physician regarding the treatment and health status of the member. 25
195188
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:
189+ (5) The procedure by which a member may receive a standing referral to a 26
190+specialist may not include a requirement that a member see a provider in addition to the 27
191+primary care physician before the standing referral is granted. 28
192+ SENATE BILL 707 5
198193
199- (i) the member is diagnosed with a condition or disease that
200-requires specialized health care services or medical care; and
201194
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
195+ (c) (1) Notwithstanding any other provision of this section, a member who is 1
196+pregnant shall receive a standing referral to an obstetrician in accordance with this 2
197+subsection. 3
205198
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.
199+ (2) After the member who is pregnant receives a standing referral to an 4
200+obstetrician, the obstetrician is responsible for the primary management of the member’s 5
201+pregnancy, including the issuance of referrals in accordance with the carrier’s policies and 6
202+procedures, through the postpartum period. 7
209203
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:
204+ (3) A written treatment plan may not be required when a standing referral 8
205+is to an obstetrician under this subsection. 9
213206
214- (i) appropriate for the member’s condition; and
207+ (d) (1) Each carrier shall establish and implement a procedure by which a 10
208+member may request a referral to a specialist or nonphysician specialist who is not part of 11
209+the carrier’s provider panel in accordance with this subsection. 12
215210
216- (ii) in accordance with the timeliness requirements for
217-determinations made by private review agents under § 15–10B–06 of this title.
211+ (2) The procedure shall provide for a referral to a specialist or nonphysician 13
212+specialist who is not part of the carrier’s provider panel if: 14
218213
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.
214+ (i) the member is diagnosed with a condition or disease that 15
215+requires specialized health care services or medical care; and 16
222216
223- (5) Each carrier shall:
217+ (ii) 1. the carrier does not have in its provider panel a specialist 17
218+or nonphysician specialist with the professional training and expertise to treat or provide 18
219+health care services for the condition or disease; or 19
224220
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]
221+ 2. the carrier cannot provide reasonable access to a specialist 20
222+or nonphysician specialist with the professional training and expertise to treat or provide 21
223+health care services for the condition or disease without unreasonable delay or travel. 22
228224
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
225+ (3) The procedure shall ensure that a request to obtain a referral to a 23
226+specialist or nonphysician specialist who is not part of the carrier’s provider panel is 24
227+addressed in a timely manner that is: 25
233228
234- [(ii)] (III) provide the information documented under item (i) of this
235-paragraph to the Commissioner on request.
229+ (i) appropriate for the member’s condition; and 26
236230
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. 272 2022 LAWS OF MARYLAND
231+ (ii) in accordance with the timeliness requirements for 27
232+determinations made by private review agents under § 15–10B–06 of this title. 28
240233
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.
234+ (4) The procedure may not be used by a carrier as a substitute for 29
235+establishing and maintaining a sufficient provider network in accordance with § 15–112 of 30
236+this title. 31
244237
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 .
238+ (5) Each carrier shall: 32
239+ 6 SENATE BILL 707
250240
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 .
261241
262- (3) EACH CARRIER SHALL US E THE REIMBURSEMENT RATE
263-ESTABLISHED UNDER PA RAGRAPH (4) OF THIS SUBSECTION T O:
242+ (i) have a system in place that documents all requests to obtain a 1
243+referral to receive a covered service from a specialist or nonphysician specialist who is not 2
244+part of the carrier’s provider panel; [and] 3
264245
265- (I) ENTER TIMELY SINGLE CASE AGREEMENTS ; AND
246+ (II) INFORM MEMBERS AND BENEFICIARIES , IN PLAIN 4
247+LANGUAGE, OF THE RIGHT PROCEDURE TO REQUEST A REFERRA L UNDER 5
248+PARAGRAPH (1) OF THIS SUBSECTION IN PRINT AND ELECTRO NIC PLAN DOCUMENTS 6
249+AND ANY PROVIDER DIRECTORY ; AND 7
266250
267- (II) PAY PROVIDERS .
251+ [(ii)] (III) provide the information documented under item (i) of this 8
252+paragraph to the Commissioner on request. 9
268253
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 .
254+ (e) (1) For EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS 10
255+SUBSECTION, FOR purposes of calculating any deductible, copayment amount, or 11
256+coinsurance payable by the member, a carrier shall treat services received in accordance 12
257+with subsection (d) of this section as if the service was provided by a provider on the 13
258+carrier’s provider panel. 14
274259
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.
260+ (2) A CARRIER SHALL ENSURE THAT SERVICES RECEIV ED IN 15
261+ACCORDANCE WITH SUBS ECTION (D) OF THIS SECTION FOR MENTAL HEALTH OR 16
262+SUBSTANCE USE DISORD ERS ARE PROVIDED AT NO GREATER COST TO T HE COVERED 17
263+INDIVIDUAL THAN IF T HE COVERED BENEFIT W ERE PROVIDED BY A PR OVIDER ON 18
264+THE CARRIER’S PROVIDER PANEL. 19
280265
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. 272
266+ (2) ON REQUEST FOR AN IN –PERSON OR TELEHEALTH VISIT, IF THE 20
267+CARRIER’S PROVIDER PANEL HAS AN INSUFFICIENT NUMB ER OR TYPE OF 21
268+PARTICIPATING SPECIA LISTS OR NONPHYSICIA N SPECIALISTS WITH T HE EXPERTISE 22
269+TO PROVIDE THE COVER ED MENTAL HEALTH OR SUBSTANCE USE DISORD ER 23
270+SERVICES REQUIRED UN DER § 15–802 OR § 15–840 OF THIS SUBTITLE TO A MEMBER 24
271+WITHIN THE APPOINTME NT WAITING TIME OR T RAVEL DISTANCE STAND ARDS 25
272+ESTABLISHED IN REGUL ATIONS, THE CARRIER SHALL CO VER THE SERVICES 26
273+PROVIDED BY A NONPAR TICIPATING PROVIDER AT NO GRE ATER COST TO THE 27
274+MEMBER THAN IF THE S ERVICES WERE PROVIDE D BY A PROVIDER ON T HE 28
275+CARRIER’S PROVIDER PANEL . 29
286276
287-– 7 –
277+ (3) EACH CARRIER SHALL US E THE REIMBURSEMENT RATE 30
278+ESTABLISHED UNDER PA RAGRAPH (4) OF THIS SUBSECTION T O: 31
288279
289- (g) (1) Each carrier shall file with the Commissioner a copy of each of the
290-procedures required under this section, including:
280+ (I) ENTER TIMELY SINGLE CASE AGREEMEN TS; AND 32
291281
292- (i) steps the carrier requires of a member to request a referral;
282+ (II) PAY PROVIDERS . 33
293283
294- (ii) the carrier’s timeline for decisions; and
284+ (4) (I) SUBJECT TO SUBPARAGRA PH (II) OF THIS PARAGRAPH , AND 34
285+NOT LATER THAN JANUARY 1, 2023, THE MARYLAND HEALTH COMMISSION SHALL 35 SENATE BILL 707 7
295286
296- (iii) the carrier’s grievance procedures for denials.
297287
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:
288+ESTABLISH A REIMBURS EMENT FORMULA TO DET ERMINE THE REIMBURSE MENT 1
289+RATE FOR NONPARTICIPATING P ROVIDERS THAT DELIVE R SERVICES UNDER 2
290+PARAGRAPH (2) OF THIS SUBSECTION . 3
300291
301- (i) in the carrier’s online network directory required under §
302-15–112(n)(1) of this title; and
292+ (II) THE MARYLAND HEALTH COMMISSION SHALL HOLD 4
293+PUBLIC MEETINGS WITH CARRIERS, MENTAL HEALTH AND SU BSTANCE USE 5
294+DISORDER PROVIDERS , CONSUMERS OF MENTAL HEALTH AND SUBSTANCE USE 6
295+DISORDER SERVICES , AND OTHER INTERESTED PARTIES TO DETERMINE THE 7
296+REIMBURSEMENT FORMUL A. 8
303297
304- (ii) on request.
298+ (f) A decision by a carrier not to provide access to or coverage of treatment or 9
299+health care services by a specialist or nonphysician specialist in accordance with this 10
300+section constitutes an adverse decision as defined under Subtitle 10A of this title if the 11
301+decision is based on a finding that the proposed service is not medically necessary, 12
302+appropriate, or efficient. 13
305303
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.
304+ (g) (1) Each carrier shall file with the Commissioner a copy of each of the 14
305+procedures required under this section, including: 15
312306
313- (I) THIS SECTION MAY NOT BE CONSTRUED TO LIMI T THE PROVISIONS IN §
314-19–710(P) OF THE HEALTH – GENERAL ARTICLE.
307+ (i) steps the carrier requires of a member to request a referral; 16
315308
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.
309+ (ii) the carrier’s timeline for decisions; and 17
324310
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.
311+ (iii) the carrier’s grievance procedures for denials. 18
328312
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. 272 2022 LAWS OF MARYLAND
313+ (2) Each carrier shall make a copy of each of the procedures filed under 19
314+paragraph (1) of this subsection available to its members: 20
334315
335-– 8 –
336-Approved by the Governor, May 12, 2022.
316+ (i) in the carrier’s online network directory required under § 21
317+15–112(n)(1) of this title; and 22
318+
319+ (ii) on request. 23
320+
321+ (H) THE CONSUMER EDUCATION AND ADVOCACY PROGRAM, ESTABLISHED 24
322+UNDER TITLE 2, SUBTITLE 3 OF THIS ARTICLE , IN COLLABORATION WIT H THE 25
323+HEALTH EDUCATION AND ADVOCACY UNIT OF THE OFFICE OF THE ATTORNEY 26
324+GENERAL, SHALL PROVIDE PUBLIC EDUCATION TO INFORM CONSUMERS OF TH EIR 27
325+RIGHT PROCEDURES TO REQUEST A REFERRA L TO A SPECIALIST OR NONPHYSICIAN 28
326+SPECIALIST AS PROVID ED FOR IN THIS SECTI ON. 29
327+
328+ (I) THIS SECTION MAY NOT BE CONSTRUED TO LIMI T THE PROVISIONS IN § 30
329+19–710(P) OF THE HEALTH – GENERAL ARTICLE. 31
330+
331+ SECTION 2. AND BE IT FURTHER ENACTED, That, on or before December 31, 32
332+2022, the health occupations boards that license, certify, or otherwise regulate mental 33
333+health and substance use disorder providers under the Health Occupations Article shall 34 8 SENATE BILL 707
334+
335+
336+report to the Senate Finance Committee and the House Health and Government 1
337+Operations Committee, in accordance with § 2–1257 of the State Government Article, on 2
338+the progress the boards have made to develop a process for providing information on mental 3
339+health and substance use disorder providers to carriers for the purpose of the carriers 4
340+reaching out to the providers regarding participation in the carriers’ provider panels. 5
341+
342+ SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall apply to all 6
343+policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 7
344+after January 1, 2023. 8
345+
346+ SECTION 3. 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 9
347+October 1, 2022. July 1, 2022. It shall remain effective for a period of 3 years and, at the 10
348+end of June 30, 2025, this Act, with no further action required by the General Assembly, 11
349+shall be abrogated and of no further force and effect. 12
350+
351+
352+
353+
354+
355+Approved:
356+________________________________________________________________________________
357+ Governor.
358+________________________________________________________________________________
359+ President of the Senate.
360+________________________________________________________________________________
361+ Speaker of the House of Delegates.