EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*sb0684*
SENATE BILL 684
J5 EMERGENCY BILL 4lr2261
CF HB 1074
By: Senator Augustine
Introduced and read first time: January 29, 2024
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: February 29, 2024
CHAPTER ______
AN ACT concerning 1
Health Insurance – Mental Health and Substance Use Disorder Benefits – 2
Sunset Repeal and Modification of Reporting Requirements 3
FOR the purpose of altering certain reporting requirements on health insurance carriers 4
relating to compliance with the federal Mental Health Parity and Addiction Equity 5
Act; altering requirements for certain analyses of nonquantitative treatment 6
limitations required of health insurance carriers; authorizing the Maryland 7
Insurance Commissioner to exercise discretion to review subsets of nonquantitative 8
treatment limitations under certain circumstances; establishing certain remedies 9
the Commissioner may use to enforce compliance with the Mental Health Parity and 10
Addiction Equity Act and related reporting requirements; establishing that a health 11
insurance carrier has the burden of persuasion in demonstrating that its health plan 12
complies with the federal Mental Health Parity and Addiction Equity Act; repealing 13
the requirement that the Commissioner use a certain form for the reporting 14
requirements; repealing the termination date for the reporting requirements; and 15
generally relating to health insurance carriers and mental health and substance use 16
disorder benefits. 17
BY repealing and reenacting, with amendments, 18
Article – Insurance 19
Section 15–144 20
Annotated Code of Maryland 21
(2017 Replacement Volume and 2023 Supplement) 22
BY repealing and reenacting, without amendments, 23 2 SENATE BILL 684
Article – Insurance 1
Section 15–1309(a)(1) and (3) 2
Annotated Code of Maryland 3
(2017 Replacement Volume and 2023 Supplement) 4
BY repealing 5
Chapter 211 of the Acts of the General Assembly of 2020 6
Section 2 7
BY repealing and reenacting, with amendments, 8
Chapter 211 of the Acts of the General Assembly of 2020 9
Section 4 10
BY repealing 11
Chapter 212 of the Acts of the General Assembly of 2020 12
Section 2 13
BY repealing and reenacting, with amendments, 14
Chapter 212 of the Acts of the General Assembly of 2020 15
Section 4 16
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 17
That the Laws of Maryland read as follows: 18
Article – Insurance 19
15–144. 20
(a) (1) In this section the following words have the meanings indicated. 21
(2) “Carrier” means: 22
(i) an insurer that holds a certificate of authority in the State and 23
provides health insurance in the State; 24
(ii) a health maintenance organization that is licensed to operate in 25
the State; 26
(iii) a nonprofit health service plan that is licensed to operate in the 27
State; or 28
(iv) any other person or organization that provides health benefit 29
plans subject to State insurance regulation. 30
(3) “Health benefit plan” means: 31
SENATE BILL 684 3
(i) for a large group or blanket plan, a health benefit plan as defined 1
in § 15–1401 of this title; 2
(ii) for a small group plan, a health benefit plan as defined in § 3
15–1201 of this title; 4
(iii) for an individual plan: 5
1. a health benefit plan as defined in § 15–1301(l) of this title; 6
or 7
2. an individual health benefit plan as defined in § 8
15–1301(o) of this title; 9
(iv) short–term limited duration insurance as defined in § 15–1301(s) 10
of this title; or 11
(v) a student health plan as defined in § 15–1318(a) of this title. 12
(4) “Medical/surgical benefits” has the meaning stated in 45 C.F.R. § 13
146.136(a) and 29 C.F.R. § 2590.712(a). 14
(5) “Mental health benefits” has the meaning stated in 45 C.F.R. § 15
146.136(a) and 29 C.F.R. § 2590.712(a). 16
(6) “Nonquantitative treatment limitation” means treatment limitations 17
as defined in 45 C.F.R. § 146.136(a) and 29 C.F.R. § 2590.712(a). 18
(7) (I) “Parity Act” means the Paul Wellstone and Pete Domenici 19
Mental Health Parity and Addiction Equity Act of 2008 [and 45 C.F.R. § 146.136 and 29 20
C.F.R. § 2590.712], AS AMENDED . 21
(II) “PARITY ACT” INCLUDES 45 C.F.R. § 146.136, 29 C.F.R. § 22
2590.712, AND ANY OTHER RELATE D FEDERAL REGULATION S FOUND IN THE CODE 23
OF FEDERAL REGULATIONS TO IMPLEM ENT OR ENFORCE THE PAUL WELLSTONE 24
AND PETE DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT OF 25
2008. 26
(8) “Parity Act classification” means: 27
(i) inpatient in–network benefits; 28
(ii) inpatient out–of–network benefits; 29
(iii) outpatient in–network benefits; 30
4 SENATE BILL 684
(iv) outpatient out–of–network benefits; 1
(v) prescription drug benefits; and 2
(vi) emergency care benefits. 3
(9) “PRODUCT” HAS THE MEANING STAT ED IN § 15–1309(A)(3) OF 4
THIS TITLE. 5
(9) (10) “Substance use disorder benefits” has the meaning stated in 45 6
C.F.R. § 146.136(a) and 29 C.F.R. § 2590.712(a). 7
(b) This section applies to a carrier that delivers or issues for delivery a health 8
benefit plan in the State. 9
(C) (1) EACH CARRIER SUBJECT TO THIS SECTION SHAL L: 10
(I) FOR EACH PARITY ACT CLASSIFICATION , IDENTIFY ALL 11
NONQUANTITATIVE TREA TMENT LIMITATIONS TH AT ARE APPLIED TO ME NTAL 12
HEALTH BENEFITS , SUBSTANCE USE DISORD ER BENEFITS, AND MEDICAL/SURGICAL 13
BENEFITS; 14
(II) IN ACCORDANCE WITH T HE PARITY ACT, PERFORM AND 15
DOCUMENT COMPARATIVE ANA LYSES OF THE DESIGN AND APPLICATION OF A LL 16
NONQUANTITATIVE TREA TMENT LIMITATIONS IM POSED ON MENTAL HEAL TH 17
BENEFITS AND SUBSTAN CE USE DISORDER BENE FITS; 18
(III) PROVIDE THE COMPARAT IVE ANALYSIS FOR EAC H 19
NONQUANTITATIVE TREA TMENT LIMITA TION REQUESTED BY TH E COMMISSIONER 20
WITHIN: 21
1. 15 WORKING DAYS AFTER A WRITTEN REQUEST ; OR 22
2. IF ADOPTED BY THE FE DERAL GOVERNMENT , LESS 23
THAN 15 WORKING DAYS TO ALIG N WITH THE FEDERAL R ULE OR REGULATION ; 24
(IV) WITHIN 30 DAYS AFTER A WRITTEN REQUEST, PROVIDE THE 25
COMPARATIVE ANALYSIS FOR EACH NONQUANTITA TIVE TREATMENT LIMIT ATION 26
AND RELATED IN OPERA TION DATA ANALYSIS , IF AVAILABLE AND REQ UESTED BY A 27
MEMBER IN ACCORDANCE WITH THE PARITY ACT DISCLOSURE REQUIR EMENTS OR, 28
FOR MEMBERS WITH IND IVIDUAL PLANS, IN ACCORDANCE WITH S UBSECTION (E)(7) 29
OF THIS SECTION; AND 30
(V) SUBMIT THE REPORTS R EQUIRED UNDER PARAGR APH (2) 31
OF THIS SUBSECTION . 32 SENATE BILL 684 5
(c) (1) (2) On or before [March 1, 2022, and March 1, 2024] MARCH 1 1
EACH YEAR, BEGINNING IN 2025 JULY 1, 2024, AND EVERY 2 YEARS THEREAFTER , 2
each carrier subject to this section shall: 3
(i) identify the five health benefit plans with the highest enrollment 4
for each product offered by the carrier in the individual, small, and large group markets; 5
and 6
(ii) submit a report to the Commissioner ON EACH PRODUCT 7
OFFERED BY THE CARRI ER IN THE INDIVIDUAL , SMALL, AND LARGE GROUP 8
MARKETS to demonstrate the carrier’s compliance with the Parity Act. 9
(2) (3) The report submitted under paragraph (1) (2) of this subsection 10
shall include [the following information]: 11
(I) ALL NONQUANTITATIVE TREATMENT LIMITATION 12
COMPARATIVE ANALYSIS INFORMATION REQUIRED UNDER THE PARITY ACT, 13
SUBSECTION (D) OF THIS SECTION , AND ANY STATE REGULATIONS for the health 14
benefit plans identified PRODUCTS IDENTIFIED under [item] PARAGRAPH (1)(i) (2) of 15
this subsection;, INCLUDING: 16
(i) a description of the process used to develop or select the medical 17
necessity criteria for mental health benefits and substance use disorder benefits and the 18
process used to develop or select the medical necessity criteria for medical and surgical 19
benefits; 20
(ii) for each Parity Act classification, identification of 21
nonquantitative treatment limitations that are applied to mental health benefits and 22
substance use disorder benefits and medical and surgical benefits; 23
(iii) identification of the description of the nonquantitative treatment 24
limitations identified under item (ii) of this paragraph in documents and instruments under 25
which the plan is established or operated; and 26
(iv) (II) the results of the A comparative analysis as described 27
under subsections (d) and (e) of this section. CONDUCTED BY THE CAR RIER ON NOT 28
FEWER THAN FIVE NONQ UANTITATIVE TREATMEN T LIMITATIONS SELECTED BY THE 29
COMMISSIONER IN ACCOR DANCE WITH PARAGRAPH (5) OF THIS SUBSECTION ; AND 30
(III) SUBJECT TO PARAGRAPH (4) OF THIS SUBSECTION , A 31
STATEMENT, SIGNED BY A CORPORAT E OFFICER, ATTESTING THAT , FOR EACH 32
PRODUCT IDENTIFIED U NDER PARAGRAPH (2) OF THIS SUBSECTION, THE SELECTED 33
NONQUANTITATIVE TREA TMENT LIMITATIONS AN D THE PROCESSES , STRATEGIES, 34
EVIDENTIARY STANDARD S, OR OTHER FACTORS USE D IN DESIGNING AND A PPLYING 35 6 SENATE BILL 684
THE SELECTED NONQUAN TITATIVE TREATMENT L IMITATIONS TO MENTAL HEALTH 1
BENEFITS, SUBSTANCE U SE DISORDER BENEFITS , AND MEDICAL /SURGICAL 2
BENEFITS ARE THE SAM E FOR ALL PLANS WITH IN THE PRODUCT , AS WRITTEN AND 3
IN OPERATION. 4
(4) IF, FOR ANY PLAN WITHIN A PRODUCT IDENTIFIED UNDER 5
PARAGRAPH (2) OF THIS SUBSECTION , THE PROCESSES , STRATEGIES, EVIDENTIARY 6
STANDARDS, OR OTHER FACTORS USE D IN DESIGNING AND A PPLYING THE 7
SELECTED NONQUANTITA TIVE TREATMENT LIMIT ATIONS TO MENTAL HEA LTH 8
BENEFITS, SUBSTANCE USE DISORD ER BENEFITS, OR MEDICAL/SURGICAL BENEFITS 9
ARE DIFFERENT , AS WRITTEN OR IN OPE RATION, FROM THE OT HER PLANS WITHIN 10
THE PRODUCT : 11
(I) THE STATEMENT REQUIR ED UNDER PARAGRAPH (3)(III) OF 12
THIS SUBSECTION SHAL L NOTE THE EXCEPTION AND IDENTIFY THE PLA N; AND 13
(II) THE CARRIER SHALL SU BMIT A SEPARATE COMP ARATIVE 14
ANALYSIS FOR THE SEL ECTED NONQUANTITATIV E TREATMENT LIMITATION S FOR 15
THE PLAN. 16
(5) (I) IN SELECTING THE NONQ UANTITATIVE TREATMEN T 17
LIMITATIONS REQUIRED TO BE INCLUDED FOR E ACH REPORTING PERIOD , THE 18
COMMISSIONER : 19
1. SHALL PRIORITIZE THE NONQUANTITATIVE 20
TREATMENT LIMITATION S IDENTIFIED BY THE COMMISSIONER AS HAVIN G THE 21
GREATEST IMPACT ON M EMBER ACCESS TO CARE ; 22
2. SHALL REVIEW THE SAM E SUBSET OF 23
NONQUANTITATIVE TREA TMENT LIMITATIONS FO R EACH CARRIER REPOR T; AND 24
3. MAY TAKE INTO CONSID ERATION OTHER FACTOR S 25
DETERMINED RELEVANT BY THE COMMISSIONER , INCLUDING COMPLAINT TRENDS, 26
FEDERAL PARITY ACT GUIDANCE , AND WHETHER THE NONQ UANTITATIVE 27
TREATMENT LIMITATION WAS SELECTED FOR A P REVIOUS REPORTING YE AR. 28
(II) OF THE FIVE SELECTED NONQUANTITATIVE TREA TMENT 29
LIMITATIONS: 30
1. NOT MORE THAN TWO MAY BE FOR UTILIZATION 31
REVIEW; AND 32
2. AT LEAST ONE MUST BE FOR NETWORK COMPOSIT ION, 33
INCLUDING REIMBURSEM ENT RATE SETTING . 34 SENATE BILL 684 7
(6) A FINDING OF NONCOMPLI ANCE FOR A PRODUCT S HALL APPLY TO 1
ALL PLANS WITHIN THE PRODUCT. 2
(d) (1) A carrier subject to this section shall conduct a comparative analysis 3
for the nonquantitative treatment limitations identified SELECTED under subsection 4
(c)(2)(ii) (C)(5) of this section as nonquantitative treatment limitations are: 5
(i) written; and 6
(ii) in operation. 7
(2) The comparative analysis of the nonquantitative treatment limitations 8
identified SELECTED under subsection (c)(2)(ii) (C)(5) of this section shall: 9
(I) demonstrate that the processes, strategies, evidentiary 10
standards, or other factors used in DESIGNING AND applying the medical necessity criteria 11
and each SELECTED nonquantitative treatment limitation to mental health benefits and 12
substance use disorder benefits in each Parity Act classification are comparable to, and are 13
applied no more stringently than, the processes, strategies, evidentiary standards, or other 14
factors used in DESIGNING AND applying the medical necessity criteria and each 15
SELECTED nonquantitative treatment limitation to medical and surgical 16
MEDICAL/SURGICAL benefits within the same Parity Act classification; AND 17
(II) INCLUDE ALL INFORMAT ION REQUIRED UNDER THE PARITY 18
ACT. 19
(3) REGARDLESS OF WHETHER IT WAS USED BEFORE T HE PARITY 20
ACT WAS ENACTED AND A S REQUESTED BY THE COMMISSION, A CARRIER SHALL 21
PERFORM AND PROVIDE A COMPARATIVE ANALYS IS FOR EACH PROCESS , STRATEGY, 22
EVIDENTIARY STANDARD , OR OTHER FACTOR USED IN DESIG NING AND APPLYING A 23
SELECTED NONQUANTITA TIVE TREATMENT LIMIT ATION USED DURING A 24
REPORTING PERIOD . 25
(e) In providing the analysis required under subsection (d) of this section, a 26
carrier shall: 27
(1) identify the factors used to determine that a nonquantitative treatment 28
limitation will apply to a benefit, including: 29
(i) the sources for the factors, INCLUDING SOURCES IN EFFECT 30
BEFORE THE ENACTMENT OF THE PARITY ACT; 31
(ii) the factors that were considered but rejected; [and] 32
8 SENATE BILL 684
(III) THE FACTORS THAT WER E IN EFFECT BEFORE T HE 1
ENACTMENT OF THE PARITY ACT AND ARE USED IN T HE DESIGN OR APPLICA TION 2
OF THE NONQUANTITATI VE TREATMENT LIMITAT ION; AND 3
[(iii)] (IV) if a factor was given more weight than another, the reason 4
for the difference in weighting; 5
(2) identify and define the specific evidentiary standards used to define the 6
factors and any other evidence relied on in designing each nonquantitative treatment 7
limitation, INCLUDING EVIDENTIAR Y STANDARDS IN EFFEC T BEFORE THE 8
ENACTMENT OF THE PARITY ACT; 9
(3) IDENTIFY AND DEFINE THE PROCESSES AND ST RATEGIES THAT 10
ARE USED TO DESIGN O R APPLY THE NONQUANT ITATIVE TREATMENT LI MITATION, 11
INCLUDING THE PROCES SES AND STRATEGIES I N EFFECT BEFORE THE ENACTMENT 12
OF THE PARITY ACT; 13
[(3)] (4) include the results of the audits, reviews, and analyses 14
performed on the nonquantitative treatment limitations identified under subsection 15
(c)(2)(ii) (C)(5) of this section to conduct the analysis required under subsection (d)(2) of 16
this section for the plans AND PRODUCTS as written; 17
[(4)] (5) include the results of the audits, reviews, and analyses 18
performed on the nonquantitative treatment limitations identified under subsection 19
(c)(2)(ii) (C)(5) of this section to conduct the analysis required under subsection (d)(2) of 20
this section for the plans AND PRODUCTS as in operation; 21
[(5)] (6) identify the measures used to ensure comparable design and 22
application of nonquantitative treatment limitations that are implemented by the carrier 23
and any entity delegated by the carrier to manage mental health benefits, substance use 24
disorder benefits, or medical/surgical benefits on behalf of the carrier; 25
[(6)] (7) disclose the specific findings and conclusions reached by the 26
carrier that indicate that the health benefit plan is in compliance with this section and the 27
Parity Act [and its implementing regulations, including 45 C.F.R. 146.136 and 29 C.F.R. 28
2590.712 and any other related federal regulations found in the Code of Federal 29
Regulations]; and 30
[(7)] (8) identify the process used to comply with the Parity Act disclosure 31
requirements for mental health benefits, substance use disorder benefits, and 32
medical/surgical benefits, including: 33
(i) the criteria for a medical necessity determination; 34
(ii) reasons for a denial of benefits; and 35 SENATE BILL 684 9
(iii) in connection with a member’s request for INDIVIDUAL OR group 1
plan information and for purposes of filing an internal coverage or grievance matter and 2
appeals, plan documents that contain information about processes, strategies, evidentiary 3
standards, and any other factors used to apply a nonquantitative treatment limitation. 4
(f) On or before [March 1, 2022, and March 1, 2024] MARCH 1 EACH YEAR, 5
BEGINNING IN 2025, each carrier subject to this section shall submit a report for the 6
health benefit plans identified under subsection (c)(1)(i) of this section to the Commissioner 7
on the following data for the immediately preceding calendar year for mental health 8
benefits, substance use disorder benefits, and medical/surgical benefits by Parity Act 9
classification: 10
(1) the frequency, reported by number and rate, with which the health 11
benefit plan received, approved, and denied prior authorization requests for mental health 12
benefits, substance use disorder benefits, and medical and surgical benefits in each Parity 13
Act classification during the immediately preceding calendar year; [and] 14
(2) the number of claims submitted for mental health benefits, substance 15
use disorder benefits, and medical and surgical benefits in each Parity Act classification 16
during the immediately preceding calendar year and the number and rates of, and reasons 17
for, denial of claims; AND 18
(3) DATA IDENTIFIED BY T HE COMMISSIONER OR FEDER AL 19
REGULATIONS TO EVALU ATE NONQUANTITATIVE TREATMENT LIMITATION 20
COMPLIANCE WITH THE IN–OPERATION STANDARD O F THE PARITY ACT. 21
(F) THE COMMISSIONER SHALL : 22
(1) DEVELOP ADDITIONAL S TANDARDIZED DATA TEM PLATES: 23
(I) TO EVALUATE THE COMP ARATIVE ANALYSIS OF 24
NONQUANTITATIVE TREA TMENT LIMITATIONS IN OPERATION; AND 25
(II) THAT MEET OR EXCEED ANY MINIMUM REQUIREM ENTS FOR 26
DATA REPORTING SPECI FIED IN FEDERAL REGU LATIONS; 27
(2) REQUIRE EACH CARRIER SUBJECT TO THIS SECT ION TO SUBMIT: 28
(I) FOR EACH PRODUCT IDE NTIFIED UNDER SUBSEC TION 29
(C)(2) OF THIS SECTION , THE DATA TEMPLATE S DESCRIBED IN ITEM (1) OF THIS 30
SUBSECTION FOR THE N ONQUANTITATIVE TREAT MENT LIMITATIONS SEL ECTED BY 31
THE COMMISSIONER FOR THE REPORTING YEAR IN AC CORDANCE WITH SUBSEC TION 32
(C)(5) OF THIS SECTION; AND 33
10 SENATE BILL 684
(II) A SEPARATE DATA TEMP LATE FOR ANY PLANS D ESCRIBED 1
IN SUBSECTION (C)(4) OF THIS SECTION; AND 2
(3) POST THE DATA TEMPLA TES ON THE ADMINISTRATION ’S WEBSITE 3
FOR A COMMENT PERIOD OF NOT LESS THAN 30 DAYS BEFORE ADOPTION . 4
(g) The reports required under subsections (c) and (f) of this section shall: 5
(1) be submitted on a standard form developed by the Commissioner THAT 6
CONFORMS TO MEETS OR EXCEEDS ANY MINIMUM REQUIREMENTS SPECIFIED IN 7
THE FEDERAL REGULATI ONS AND SUB –REGULATORY GUIDANCE ON 8
NONQUANTITATIVE TREA TMENT LIMITATIONS COMPARATIVE ANALYSIS 9
REPORTING; 10
(2) be submitted by the carrier that issues or delivers the health benefit 11
plan PRODUCT; 12
(3) be prepared in coordination with any entity the carrier contracts with 13
to provide mental health benefits and substance use disorder benefits; 14
(4) contain a statement, signed by a corporate officer, attesting to the 15
accuracy of the information contained in the report; 16
(5) be available to plan members and the public on the carrier’s website in 17
a summary form that removes confidential or proprietary information and is developed by 18
the Commissioner in accordance with subsection [(m)(2)] (N)(2) of this section; and 19
(6) exclude any identifying information of any plan member. 20
(h) (1) A carrier submitting a report under subsections (c) and (f) of this section 21
may submit a written request to the Commissioner that disclosure of specific information 22
included in the report be denied under the Public Information Act and, if submitting a 23
request, shall: 24
(i) identify the particular information the disclosure of which the 25
carrier requests be denied; and 26
(ii) cite the statutory authority under the Public Information Act 27
that authorizes denial of access to the information. 28
(2) The Commissioner may review a request submitted under paragraph 29
(1) of this subsection on receipt of a request for access to the information under the Public 30
Information Act. 31
SENATE BILL 684 11
(3) The Commissioner may notify the carrier that submitted the request 1
under paragraph (1) of this subsection before granting access to information that was the 2
subject of the request. 3
(4) A carrier shall disclose to a member on request any plan information 4
contained in a report that is required to be disclosed to that member under federal or State 5
law. 6
(i) (1) The Commissioner shall: 7
[(1)] (I) review each report submitted in accordance with subsections (c), 8
(D), and (f) of this section to assess each carrier’s compliance with the Parity Act FOR EACH 9
PARITY ACT CLASSIFICATION ; 10
[(2)] (II) notify a carrier in writing of any noncompliance with the Parity 11
Act before issuing an administrative order; and 12
[(3)] (III) within 90 days after the notice of noncompliance is issued, allow 13
the carrier to: 14
[(i)] 1. submit a compliance plan to the Administration to comply 15
with the Parity Act; and 16
[(ii)] 2. reprocess any claims that were improperly denied, in 17
whole or in part, because of the noncompliance. 18
(2) THE COMMISSIONER MAY EXER CISE DISCRETION TO R EVIEW A 19
SUBSET OF NONQUANTIT ATIVE TREATMENT LIMI TATIONS FOR THE PURP OSES OF 20
THIS SECTION IF THE COMMISSIONER : 21
(I) AFTER THE REPORTING DEADLINES ESTABLISHE D UNDER 22
SUBSECTIONS (C) AND (F) OF THIS SECTION , IDENTIFIES THE NONQU ANTITATIVE 23
TREATMENT LIMITATION S THAT WILL BE REVIE WED BY THE COMMISSIONER ; 24
(II) DESCRIBES AND POSTS ON THE ADMINISTRATION’S 25
WEBSITE THE CRITERIA USED TO IDENTIFY THE NONQUANTITATIVE TREA TMENT 26
LIMITATIONS THAT WIL L BE REVIEWED EACH Y EAR; 27
(III) REVIEWS NONQUANTITAT IVE TREATMENT LIMITA TIONS 28
THAT HAVE THE GREATE ST EFFECT ON ACCESS TO MENTAL HEALTH AND 29
SUBSTANCE USE DISO RDER CARE; 30
(IV) REVIEWS THE SAME SUB SET OF NONQUANTITATI VE 31
TREATMENT LIMITATION S FOR EACH CARRIER R EPORT; 32
12 SENATE BILL 684
(V) REVIEWS NOT LESS THA N 10 NONQUANTITATIVE 1
TREATMENT LIMITATION S FOR EACH CARRIER R EPORT; AND 2
(VI) ISSUES A DETERMINATI ON IN ANY MATTER THAT 3
IMPLICATES PARITY ACT COMPLIANCE REGARD LESS OF WHETHER A 4
NONQUANTITATIVE TREA TMENT LIMITATION AT ISSUE IN THE MATTER HAS BEEN 5
REVIEWED UNDER THIS SECTION. 6
(2) THE COMMISSIONER MAY REQU IRE CARRIERS TO COMP LETE 7
DATA TEMPLATES FOR A NONQUANTITATIVE TREATMENT LIMITATION MORE 8
FREQUENTLY THAN EVER Y 2 YEARS. 9
(j) (1) If the Commissioner finds that the carrier failed to submit a complete 10
report required under subsection (c) or (f) of this section, the Commissioner may: 11
(I) TAKE ACTION AUTHORIZ ED UNDER PARAGRAPH (2) OF THIS 12
SUBSECTION; 13
(II) IN ACCORDANCE WITH § 2–208 OF THIS ARTICLE , CHARGE 14
THE CARRIER FOR ANY ADDITIONAL EXPENSES INCURRED BY THE COMMISSIONER 15
TO REVIEW ADDITIONAL REPORTS; 16
(III) IMPOSE A PENALTY FOR EACH DAY THAT THE CA RRIER 17
FAILS TO SUBMIT INFO RMATION REQUIRED BY THE COMMISSIONER TO EVALU ATE 18
COMPLIANCE ; OR 19
(IV) impose any penalty or take any action as authorized: 20
(1) 1. for an insurer, nonprofit health service plan, or any other 21
person subject to this section, under this article; or 22
(2) 2. for a health maintenance organization, under this article 23
or the Health – General Article. 24
(2) IF THE COMMISSIONER CANNOT M AKE A DETERMINATION THAT A 25
SPECIFIC CONDUCT OR PRACTICE IS COMPLIAN T WITH THE PARITY ACT BECAUSE 26
THE CARRIER FAILED TO PRO VIDE A SUFFICIENT CO MPARATIVE ANALYSIS F OR A 27
NONQUANTITATIVE TREA TMENT LIMITATION , THE COMMISSIONER MAY : 28
(I) ISSUE AN ADMINISTRAT IVE ORDER REQUIRING THE 29
CARRIER OR AN ENTITY DELEGATED BY THE CAR RIER TO TAKE THE FOL LOWING 30
ACTION UNTIL THE COMMISSIONER CAN MAKE A DETERMINATION OF C OMPLIANCE 31
WITH THE PARITY ACT: 32
SENATE BILL 684 13
1. MODIFY THE CONDUCT O R PRACTICE AS SPECIF IED 1
BY THE COMMISSIONER ; 2
2. CEASE THE CONDUCT OR PRACTICE; OR 3
3. SUBMIT PERIODIC DATA RELATED TO THE CONDU CT 4
OR PRACTICE; OR 5
(II) SUBJECT TO PARAGRAPH (3) OF THIS SUBSECTION , 6
REQUIRE THE CARRIER TO PERFORM A NEW COM PARATIVE ANALYSIS . 7
(3) THE COMMISSIONER MAY REQU IRE THE CARRIER TO E STABLISH 8
SPECIFIC QUANTITATIV E THRESHOLDS FOR EVI DENTIARY STANDARDS A ND 9
CONDUCT A NEW COMPARATIVE ANALYSIS FOR A NONQUANTITATIV E TREATMENT 10
LIMITATION IF THE COMMISSIONER DETERMIN ES A CARRIER FAILED TO PROVIDE A 11
SUFFICIENT COMPARATI VE ANALYSIS BECAUSE THE CARRIER DID NOT : 12
(I) USE APPLICABLE QUANT ITATIVE THRESHOLDS F OR THE 13
EVIDENTIARY ST ANDARD; OR 14
(II) PROVIDE A SPECIFIC , DETAILED, AND REASONED 15
EXPLANATION OF HOW T HE CARRIER ENSURES T HAT THE FACTORS FOR THE 16
NONQUANTITATIVE TREA TMENT LIMITATION ARE BEING APPLIED COMPAR ABLY 17
AND NO MORE STRINGEN TLY TO MENTAL HEALTH AND SUBSTANCE USE DI SORDER 18
SERVICES. 19
(4) SUBSECTION (I)(1)(III) OF THIS SECTION DOES NOT APPLY TO THE 20
FAILURE OF A CARRIER TO SUBMIT A COMPLETE REPORT. 21
(k) If, as a result of the review required under subsection [(i)(1)] (I)(1)(I) of this 22
section, the Commissioner finds that the carrier failed to comply with [the provisions of] 23
the Parity Act, [and] did not submit a compliance plan to adequately correct the 24
noncompliance, OR FAILED TO SUBMIT INFORMATION THAT IS REQUIRED TO 25
EVALUATE COMPLIANCE WITH THE PARITY ACT, the Commissioner may: 26
(1) issue an administrative order that requires: 27
(i) the carrier or an entity delegated by the carrier to cease the 28
noncompliant conduct or practice; [or] 29
(II) THE CARRIER OR AN EN TITY DELEGATED BY THE CAR RIER 30
TO CEASE THE IMPLEME NTATION OF THE NONQU ANTITATIVE TREATMENT 31
LIMITATION; OR 32
14 SENATE BILL 684
[(ii)] (III) the carrier to provide a payment that has been denied 1
improperly because of the noncompliance, INCLUDING A FAILURE TO PROVIDE 2
INFORMATION THAT DEMONSTRATES CO MPLIANCE; [or] 3
(2) IMPOSE A PENALTY OF NOT LESS THAN $1,000 FOR EACH DAY IN 4
WHICH THE CARRIER FA ILS TO SUBMIT INFORM ATION REQUIRED BY TH E 5
COMMISSIONER TO EVALU ATE COMPLIANCE ; OR 6
[(2)] (3) impose any OTHER penalty or take any action as authorized: 7
(i) for an insurer, nonprofit health service plan, or any other person 8
subject to this section, under this article; or 9
(ii) for a health maintenance organization, under this article or the 10
Health – General Article. 11
(L) (1) A CARRIER SHALL HAVE T HE BURDEN OF PERSUAS ION IN 12
DEMONSTRATING THAT I TS HEALTH PLAN DESIGN AND APPLICATI ON OF A 13
NONQUANTITATIVE TREA TMENT LIMITATION COMPLIES WITH THE PARITY ACT: 14
(I) IN ANY REVIEW CONDUC TED BY THE COMMISSIONER 15
UNDER THIS SECTION ; OR 16
(II) IN ANY MATTER FILED WITH COMPLAINT INVESTIGAT ION OR 17
MARKET CONDUCT ACTIO N UNDERTAKEN BY THE COMMISSIONER THAT INV OLVES 18
THE APPLICATION OF T HE PARITY ACT. 19
(2) (I) A FAILURE OF A CARRIER TO SUBMIT COMPLETE PARITY 20
ACT COMPLIANCE INFORM ATION REQUIRED UNDER THIS SECTION OR IN 21
CONNECTION WITH A MATTER FILED WITH AN INVESTIGATION OR EXAMINATION BY 22
THE COMMISSIONER SHALL CO NSTITUTE NONCOMPLIAN CE WITH THE PARITY ACT. 23
(II) SUBSECTION (I)(1)(III) OF THIS SECTION DOES NOT APPLY 24
TO A CARRIER THAT FA ILS TO SUBMIT COMPLE TE PARITY ACT COMPLIANCE 25
INFORMATION . 26
[(l)] (M) In determining an appropriate penalty under subsection (j) or (k) of this 27
section, the Commissioner shall consider the late filing of a report required under 28
subsection (c) or (f) of this section and any parity violation to be a serious violation with a 29
significantly deleterious effect on the public. 30
[(m)] (N) On or before December 31, 2021, the THE Commissioner shall create: 31
(1) a standard form for entities to submit the reports in accordance with 32
subsection (g)(1) of this section; and 33 SENATE BILL 684 15
(2) a summary form for entities to post to their websites in accordance with 1
subsection (g)(5) of this section. 2
[(n)] (O) On or before December 31, [2021] 2024, the THE Commissioner shall, 3
in consultation with interested stakeholders, adopt regulations to implement this section, 4
including to ensure uniform definitions and methodology for the reporting requirements 5
established under this section. 6
15–1309. 7
(a) (1) In this section the following words have the meanings indicated. 8
(3) (i) “Product” means a discrete package of health benefits that are 9
offered using a particular product network type within a geographic service area. 10
(ii) “Product” comprises all plans offered within the product. 11
Chapter 211 of the Acts of 2020 12
[SECTION 2. AND B E IT FURTHER ENACTED, That the standard form the 13
Maryland Insurance Commissioner is required to develop under § 15–144(m)(1) of the 14
Insurance Article, as enacted by Section 1 of this Act, for the report required under § 15
15–144(c) of the Insurance Article, as enacted by Section 1 of this Act, shall be the National 16
Association of Insurance Commissioners’ Data Collection Tool for Mental Health Parity 17
Analysis, Nonquantitative Treatment Limitations and any amendments by the 18
Commissioner to the tool necessary to incorporate the requirements of § 15–144(c), (d), and 19
(e) of the Insurance Article, as enacted by Section 1 of this Act.] 20
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 21
October 1, 2020. [It shall remain in effect for a period of 6 years and, at the end of 22
September 30, 2026, this Act, with no further action required by the General Assembly, 23
shall be abrogated and of no further force and effect.] 24
Chapter 212 of the Acts of 2020 25
[SECTION 2. AND BE IT FURTHER ENACTED, That the st andard form the 26
Maryland Insurance Commissioner is required to develop under § 15–144(m)(1) of the 27
Insurance Article, as enacted by Section 1 of this Act, for the report required under § 28
15–144(c) of the Insurance Article, as enacted by Section 1 of this Act, shall be the National 29
Association of Insurance Commissioners’ Data Collection Tool for Mental Health Parity 30
Analysis, Nonquantitative Treatment Limitations and any amendments by the 31
Commissioner to the tool necessary to incorporate the requirements of § 15–144(c), (d), and 32
(e) of the Insurance Article, as enacted by Section 1 of this Act.] 33
16 SENATE BILL 684
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 1
October 1, 2020. [It shall remain in effect for a period of 6 years and, at the end of 2
September 30, 2026, this Act, with no further action required by the General Assembly, 3
shall be abrogated and of no further force and effect.] 4
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect July 5
1, 2024 is an emergency measure, is necessary for the immediate preservation of the public 6
health or safety, has been passed by a yea and nay vote supported by three–fifths of all the 7
members elected to each of the two Houses of the General Assembly, and shall take effect 8
from the date it is enacted. 9
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.