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Chapter 233
(Senate Bill 684)
AN ACT concerning
Health Insurance – Mental Health and Substance Use Disorder Benefits –
Sunset Repeal and Modification of Reporting Requirements
FOR the purpose of altering certain reporting requirements on health insurance carriers
relating to compliance with the federal Mental Health Parity and Addiction Equity
Act; altering requirements for certain analyses of nonquantitative treatment
limitations required of health insurance carriers; authorizing the Maryland
Insurance Commissioner to exercise discretion to review subsets of nonquantitative
treatment limitations under certain circumstances; establishing certain remedies
the Commissioner may use to enforce compliance with the Mental Health Parity and
Addiction Equity Act and related reporting requirements; establishing that a health
insurance carrier has the burden of persuasion in demonstrating that its health plan
complies with the federal Mental Health Parity and Addiction Equity Act; repealing
the requirement that the Commissioner use a certain form for the reporting
requirements; repealing the termination date for the reporting requirements; and
generally relating to health insurance carriers and mental health and substance use
disorder benefits.
BY repealing and reenacting, with amendments,
Article – Insurance
Section 15–144
Annotated Code of Maryland
(2017 Replacement Volume and 2023 Supplement)
BY repealing and reenacting, without amendments,
Article – Insurance
Section 15–1309(a)(1) and (3)
Annotated Code of Maryland
(2017 Replacement Volume and 2023 Supplement)
BY repealing
Chapter 211 of the Acts of the General Assembly of 2020
Section 2
BY repealing and reenacting, with amendments,
Chapter 211 of the Acts of the General Assembly of 2020
Section 4
BY repealing
Chapter 212 of the Acts of the General Assembly of 2020
Section 2 Ch. 233 2024 LAWS OF MARYLAND
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BY repealing and reenacting, with amendments,
Chapter 212 of the Acts of the General Assembly of 2020
Section 4
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Insurance
15–144.
(a) (1) In this section the following words have the meanings indicated.
(2) “Carrier” means:
(i) an insurer that holds a certificate of authority in the State and
provides health insurance in the State;
(ii) a health maintenance organization that is licensed to operate in
the State;
(iii) a nonprofit health service plan that is licensed to operate in the
State; or
(iv) any other person or organization that provides health benefit
plans subject to State insurance regulation.
(3) “Health benefit plan” means:
(i) for a large group or blanket plan, a health benefit plan as defined
in § 15–1401 of this title;
(ii) for a small group plan, a health benefit plan as defined in §
15–1201 of this title;
(iii) for an individual plan:
1. a health benefit plan as defined in § 15–1301(l) of this title;
or
2. an individual health benefit plan as defined in §
15–1301(o) of this title;
(iv) short–term limited duration insurance as defined in § 15–1301(s)
of this title; or WES MOORE, Governor Ch. 233
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(v) a student health plan as defined in § 15–1318(a) of this title.
(4) “Medical/surgical benefits” has the meaning stated in 45 C.F.R. §
146.136(a) and 29 C.F.R. § 2590.712(a).
(5) “Mental health benefits” has the meaning stated in 45 C.F.R. §
146.136(a) and 29 C.F.R. § 2590.712(a).
(6) “Nonquantitative treatment limitation” means treatment limitations
as defined in 45 C.F.R. § 146.136(a) and 29 C.F.R. § 2590.712(a).
(7) (I) “Parity Act” means the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 [and 45 C.F.R. § 146.136 and 29
C.F.R. § 2590.712], AS AMENDED .
(II) “PARITY ACT” INCLUDES 45 C.F.R. § 146.136, 29 C.F.R. §
2590.712, AND ANY OTHER RELATE D FEDERAL REGULATION S FOUND IN THE CODE
OF FEDERAL REGULATIONS TO IMPLEM ENT OR ENFORCE THE PAUL WELLSTONE
AND PETE DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT OF
2008.
(8) “Parity Act classification” means:
(i) inpatient in–network benefits;
(ii) inpatient out–of–network benefits;
(iii) outpatient in–network benefits;
(iv) outpatient out–of–network benefits;
(v) prescription drug benefits; and
(vi) emergency care benefits.
(9) “PRODUCT” HAS THE MEANING STAT ED IN § 15–1309(A)(3) OF
THIS TITLE.
(9) (10) “Substance use disorder benefits” has the meaning stated in 45
C.F.R. § 146.136(a) and 29 C.F.R. § 2590.712(a).
(b) This section applies to a carrier that delivers or issues for delivery a health
benefit plan in the State.
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(C) (1) EACH CARRIER SUBJECT TO THIS SECTION SHAL L:
(I) FOR EACH PARITY ACT CLASSIFICATION , IDENTIFY ALL
NONQUANTITATIVE TRE ATMENT LIMITATIONS T HAT ARE APPLIED TO M ENTAL
HEALTH BENEFITS , SUBSTANCE USE DISORD ER BENEFITS, AND MEDICAL/SURGICAL
BENEFITS;
(II) IN ACCORDANCE WITH T HE PARITY ACT, PERFORM AND
DOCUMENT COMPARATIVE ANALYSES OF THE DESI GN AND APPLICATION O F ALL
NONQUANTITATIVE TREATMENT LIMITATIONS IMPOSED ON MENTAL HEALTH
BENEFITS AND SUBSTAN CE USE DISORDER BENE FITS;
(III) PROVIDE THE COMPARAT IVE ANALYSIS FOR EAC H
NONQUANTITATIVE TREA TMENT LIMITATION REQ UESTED BY THE COMMISSIONER
WITHIN:
1. 15 WORKING DAYS A FTER A WRITTEN REQUE ST; OR
2. IF ADOPTED BY THE FE DERAL GOVERNMENT , LESS
THAN 15 WORKING DAYS TO ALIG N WITH THE FEDERAL R ULE OR REGULATION ;
(IV) WITHIN 30 DAYS AFTER A WRITTEN REQUEST, PROVIDE THE
COMPARATIVE ANALYSIS FOR EACH NONQUANTITA TIVE TREATMENT LIMITATION
AND RELATED IN OPERA TION DATA ANALYSIS , IF AVAILABLE AND REQ UESTED BY A
MEMBER IN ACCORDANCE WITH THE PARITY ACT DISCLOSURE REQUIR EMENTS OR,
FOR MEMBERS WITH IND IVIDUAL PLANS, IN ACCORDANCE WITH S UBSECTION (E)(7)
OF THIS SECTION; AND
(V) SUBMIT THE REPORTS R EQUIRED UNDER PARAGR APH (2)
OF THIS SUBSECTION .
(c) (1) (2) On or before [March 1, 2022, and March 1, 2024] MARCH 1
EACH YEAR, BEGINNING IN 2025 JULY 1, 2024, AND EVERY 2 YEARS THEREAFTER ,
each carrier subject to this section shall:
(i) identify the five health benefit plans with the highest enrollment
for each product offered by the carrier in the individual, small, and large group markets;
and
(ii) submit a report to the Commissioner ON EACH PRODUCT
OFFERED BY THE CARRIER IN THE INDIV IDUAL, SMALL, AND LARGE GROUP
MARKETS to demonstrate the carrier’s compliance with the Parity Act.
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(2) (3) The report submitted under paragraph (1) (2) of this subsection
shall include [the following information]:
(I) ALL NONQUA NTITATIVE TREATMENT LIMITATION
COMPARATIVE ANALYSIS INFORMATION REQUIRED UNDER THE PARITY ACT,
SUBSECTION (D) OF THIS SECTION , AND ANY STATE REGULATIONS for the health
benefit plans identified PRODUCTS IDENTIFIED under [item] PARAGRAPH (1)(i) (2) of
this subsection;, INCLUDING:
(i) a description of the process used to develop or select the medical
necessity criteria for mental health benefits and substance use disorder benefits and the
process used to develop or select the medical necessity criteria for medical and surgical
benefits;
(ii) for each Parity Act classification, identification of
nonquantitative treatment limitations that are applied to mental health benefits and
substance use disorder benefits and medical and surgical benefits;
(iii) identification of the description of the nonquantitative treatment
limitations identified under item (ii) of this paragraph in documents and instruments under
which the plan is established or operated; and
(iv) (II) the results of the A comparative analysis as described
under subsections (d) and (e) of this section. CONDUCTED BY THE CAR RIER ON NOT
FEWER THAN FIVE NONQ UANTITATIVE TREATMEN T LIMITATIONS SELECT ED BY THE
COMMISSIONER IN ACCOR DANCE WITH PARAGRAPH (5) OF THIS SUBSECTION ; AND
(III) SUBJECT TO PARAGRAPH (4) OF THIS SUBSECTION , A
STATEMENT, SIGNED BY A CORPORAT E OFFICER, ATTESTING THAT , FOR EACH
PRODUCT IDENTIFIED U NDER PARAGRAPH (2) OF THIS SUBSECTION , THE SELECTED
NONQUANTITATIVE TREA TMENT LIMITATIONS AN D THE PROCESSES , STRATEGIES,
EVIDENTIARY STANDARD S, OR OTHER FACTORS USE D IN DESIGNING AND A PPLYING
THE SELECTED NONQUAN TITATIVE TREATMENT L IMITATIONS TO MENTAL HEALTH
BENEFITS, SUBSTANCE USE DISORD ER BENEFITS , AND MEDICAL /SURGICAL
BENEFITS ARE THE SAM E FOR ALL PLANS WITH IN THE PRODUCT, AS WRITTEN AND
IN OPERATION.
(4) IF, FOR ANY PLAN WITHIN A PRODUCT IDENTIFIED UNDER
PARAGRAPH (2) OF THIS SUBSECTION , THE PROCESSES , STRATEGIES, EVIDENTIARY
STANDARDS, OR OTHER FACTORS USE D IN DESIGNING AND A PPLYING THE
SELECTED NONQUANTITA TIVE TREATMENT LIMITATI ONS TO MENTAL HEALTH
BENEFITS, SUBSTANCE USE DISORD ER BENEFITS, OR MEDICAL/SURGICAL BENEFITS
ARE DIFFERENT , AS WRITTEN OR IN OPE RATION, FROM THE OTHER PLANS WITHIN
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(I) THE STATEMENT REQUIR ED UNDER PARAGRAPH (3)(III) OF
THIS SUBSECTION SHAL L NOTE THE EXCEPTION AND IDENTIFY THE PLA N; AND
(II) THE CARRIER SHALL SU BMIT A SEPARATE COMP ARATIVE
ANALYSIS FOR THE SEL ECTED NONQUANTITATIV E TREATMENT LIMITATI ONS FOR
THE PLAN.
(5) (I) IN SELECTING THE NONQ UANTITATIVE TREATMEN T
LIMITATIONS REQUIRED TO BE INCLUDED FOR E ACH REPORTING PERIOD , THE
COMMISSIONER :
1. SHALL PRIORITIZE THE NONQUANTITATIVE
TREATMENT LIMITATION S IDENTIFIED BY THE COMMISSIONER AS HAVIN G THE
GREATEST IMPACT ON M EMBER ACCESS TO CARE ;
2. SHALL REVIE W THE SAME SUBSET OF
NONQUANTITATIVE TREA TMENT LIMITATIONS FO R EACH CARRIER REPOR T; AND
3. MAY TAKE INTO CONSID ERATION OTHER FACTOR S
DETERMINED RELEVANT BY THE COMMISSIONER , INCLUDING COMPLAINT TRENDS,
FEDERAL PARITY ACT GUIDANCE , AND WHETHER THE NON QUANTITATIVE
TREATMENT LIMITATION WAS SELECTED FOR A P REVIOUS REPORTING YE AR.
(II) OF THE FIVE SELECTED NONQUANTITATIVE TREA TMENT
LIMITATIONS:
1. NOT MORE THAN TWO MA Y BE FOR UTILIZATION
REVIEW; AND
2. AT LEAST ONE MUST BE FOR NETWORK COMPOSITION ,
INCLUDING REIMBURSEM ENT RATE SETTING .
(6) A FINDING OF NONCOMPLI ANCE FOR A PRODUCT S HALL APPLY TO
ALL PLANS WITHIN THE PRODUCT.
(d) (1) A carrier subject to this section shall conduct a comparative analysis
for the nonquantitative treatment limitations identified SELECTED under subsection
(c)(2)(ii) (C)(5) of this section as nonquantitative treatment limitations are:
(i) written; and
(ii) in operation.
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(2) The comparative analysis of the nonquantitative treatment limitations
identified SELECTED under subsection (c)(2)(ii) (C)(5) of this section shall:
(I) demonstrate that the processes, strategies, evidentiary
standards, or other factors used in DESIGNING AND applying the medical necessity criteria
and each SELECTED nonquantitative treatment limitation to mental health benefits and
substance use disorder benefits in each Parity Act classification are comparable to, and are
applied no more stringently than, the processes, strategies, evidentiary standards, or other
factors used in DESIGNING AND applying the medical necessity criteria and each
SELECTED nonquantitative treatment limitation to medical and surgical
MEDICAL/SURGICAL benefits within the same Parity Act classification; AND
(II) INCLUDE ALL INFORMAT ION REQUIRED UNDER THE PARITY
ACT.
(3) REGARDLESS OF WHETHER IT WAS USED BEFORE T HE PARITY
ACT WAS ENACTED AND A S REQUESTED BY THE COMMISSION, A CARRIER SHALL
PERFORM AND PROVIDE A COMPARATIVE ANALYS IS FOR EACH PROCESS , STRATEGY,
EVIDENTIARY STANDARD , OR OTHER FACTOR USED IN DESIG NING AND APPLYING A
SELECTED NONQUANTITA TIVE TREATMENT LIMIT ATION USED DURING A
REPORTING PERIOD .
(e) In providing the analysis required under subsection (d) of this section, a
carrier shall:
(1) identify the factors used to determine that a nonquantitative treatment
limitation will apply to a benefit, including:
(i) the sources for the factors, INCLUDING SOURCES IN EFFECT
BEFORE THE ENACTMENT OF THE PARITY ACT;
(ii) the factors that were considered but rejected; [and]
(III) THE FACTORS THAT WER E IN EFFECT BEFORE T HE
ENACTMENT OF THE PARITY ACT AND ARE USED IN T HE DESIGN OR APPLICA TION
OF THE NONQUANTITATI VE TREATMENT LIMITAT ION; AND
[(iii)] (IV) if a factor was given more weight than another, the reason
for the difference in weighting;
(2) identify and define the specific evidentiary standards used to define the
factors and any other evidence relied on in designing each nonquantitative treatment
limitation, INCLUDING EVIDENTIAR Y STANDARDS IN EFFEC T BEFORE THE
ENACTMENT OF THE PARITY ACT; Ch. 233 2024 LAWS OF MARYLAND
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(3) IDENTIFY AND DEFINE THE PROCESSES AND ST RATEGIES THAT
ARE USED TO DESIGN O R APPLY THE NONQUANT ITATIVE TREATMENT LI MITATION,
INCLUDING THE PROCES SES AND STRATEGIES I N EFFECT BEFORE THE ENACTMENT
OF THE PARITY ACT;
[(3)] (4) include the results of the audits, reviews, and analyses
performed on the nonquantitative treatment limitations identified under subsection
(c)(2)(ii) (C)(5) of this section to conduct the analysis required under subsection (d)(2) of
this section for the plans AND PRODUCTS as written;
[(4)] (5) include the results of the audits, reviews, and analyses
performed on the nonquantitative treatment limitations identified under subsection
(c)(2)(ii) (C)(5) of this section to conduct the analysis required under subsection (d)(2) of
this section for the plans AND PRODUCTS as in operation;
[(5)] (6) identify the measures used to ensure comparable design and
application of nonquantitative treatment limitations that are implemented by the carrier
and any entity delegated by the carrier to manage mental health benefits, substance use
disorder benefits, or medical/surgical benefits on behalf of the carrier;
[(6)] (7) disclose the specific findings and conclusions reached by the
carrier that indicate that the health benefit plan is in compliance with this section and the
Parity Act [and its implementing regulations, including 45 C.F.R. 146.136 and 29 C.F.R.
2590.712 and any other related federal regulations found in the Code of Federal
Regulations]; and
[(7)] (8) identify the process used to comply with the Parity Act disclosure
requirements for mental health benefits, substance use disorder benefits, and
medical/surgical benefits, including:
(i) the criteria for a medical necessity determination;
(ii) reasons for a denial of benefits; and
(iii) in connection with a member’s request for INDIVIDUAL OR group
plan information and for purposes of filing an internal coverage or grievance matter and
appeals, plan documents that contain information about processes, strategies, evidentiary
standards, and any other factors used to apply a nonquantitative treatment limitation.
(f) On or before [March 1, 2022, and March 1, 2024] MARCH 1 EACH YEAR,
BEGINNING IN 2025, each carrier subject to this section shall submit a report for the
health benefit plans identified under subsection (c)(1)(i) of this section to the Commissioner
on the following data for the immediately preceding calendar year for mental health WES MOORE, Governor Ch. 233
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benefits, substance use disorder benefits, and medical/surgical benefits by Parity Act
classification:
(1) the frequency, reported by number and rate, with which the health
benefit plan received, approved, and denied prior authorization requests for mental health
benefits, substance use disorder benefits, and medical and surgical benefits in each Parity
Act classification during the immediately preceding calendar year; [and]
(2) the number of claims submitted for mental health benefits, substance
use disorder benefits, and medical and surgical benefits in each Parity Act classification
during the immediately preceding calendar year and the number and rates of, and reasons
for, denial of claims; AND
(3) DATA IDENTIFIED BY T HE COMMISSIONER OR FEDER AL
REGULATIONS TO EVALU ATE NONQUANTITATIVE TREATMENT LIMITATION
COMPLIANCE WITH THE IN–OPERATION STANDARD O F THE PARITY ACT.
(F) THE COMMISSIONER SHALL :
(1) DEVELOP ADDITIONAL S TANDARDIZED DATA TEM PLATES:
(I) TO EVALUATE THE COMP ARATIVE ANALYSIS OF
NONQUANTITATIVE TREA TMENT LIMITATIONS IN OPERATION; AND
(II) THAT MEET OR EXCEED ANY MINIMUM REQUIREM ENTS FOR
DATA REPORTING SPECI FIED IN FEDERAL REGU LATIONS;
(2) REQUIRE EACH CARRIER SUBJECT TO THIS SECT ION TO SUBMIT:
(I) FOR EACH PRODUCT IDE NTIFIED UNDER SUBSEC TION
(C)(2) OF THIS SECTION , THE DATA TEMPLATES D ESCRIBED IN ITEM (1) OF THIS
SUBSECTION FOR THE N ONQUANTITATIVE TREAT MENT LIMITATIONS SE LECTED BY
THE COMMISSIONER FOR THE REPORTING YEAR IN AC CORDANCE WITH SUBSEC TION
(C)(5) OF THIS SECTION; AND
(II) A SEPARATE DATA TEMP LATE FOR ANY PLANS D ESCRIBED
IN SUBSECTION (C)(4) OF THIS SECTION; AND
(3) POST THE DATA TEMPLA TES ON THE ADMINISTRATION ’S WEBSITE
FOR A COMMENT PERIOD OF NOT LESS THAN 30 DAYS BEFORE ADOPTION .
(g) The reports required under subsections (c) and (f) of this section shall:
(1) be submitted on a standard form developed by the Commissioner THAT
CONFORMS TO MEETS OR EXCEEDS ANY MINIMUM REQUIREMENTS SPECIFIED IN Ch. 233 2024 LAWS OF MARYLAND
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THE FEDERAL REGULATI ONS AND SUB –REGULATORY GUIDANCE ON
NONQUANTITATIVE TREA TMENT LIMITATIONS COMPARATIVE ANALYSIS
REPORTING ;
(2) be submitted by the carrier that issues or delivers the health benefit
plan PRODUCT;
(3) be prepared in coordination with any entity the carrier contracts with
to provide mental health benefits and substance use disorder benefits;
(4) contain a statement, signed by a corporate officer, attesting to the
accuracy of the information contained in the report;
(5) be available to plan members and the public on the carrier’s website in
a summary form that removes confidential or proprietary information and is developed by
the Commissioner in accordance with subsection [(m)(2)] (N)(2) of this section; and
(6) exclude any identifying information of any plan member.
(h) (1) A carrier submitting a report under subsections (c) and (f) of this section
may submit a written request to the Commissioner that disclosure of specific information
included in the report be denied under the Public Information Act and, if submitting a
request, shall:
(i) identify the particular information the disclosure of which the
carrier requests be denied; and
(ii) cite the statutory authority under the Public Information Act
that authorizes denial of access to the information.
(2) The Commissioner may review a request submitted under paragraph
(1) of this subsection on receipt of a request for access to the information under the Public
Information Act.
(3) The Commissioner may notify the carrier that submitted the request
under paragraph (1) of this subsection before granting access to information that was the
subject of the request.
(4) A carrier shall disclose to a member on request any plan information
contained in a report that is required to be disclosed to that member under federal or State
law.
(i) (1) The Commissioner shall:
WES MOORE, Governor Ch. 233
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[(1)] (I) review each report submitted in accordance with subsections (c),
(D), and (f) of this section to assess each carrier’s compliance with the Parity Act FOR EACH
PARITY ACT CLASSIFICATION ;
[(2)] (II) notify a carrier in writing of any noncompliance with the Parity
Act before issuing an administrative order; and
[(3)] (III) within 90 days after the notice of noncompliance is issued, allow
the carrier to:
[(i)] 1. submit a compliance plan to the Administration to comply
with the Parity Act; and
[(ii)] 2. reprocess any claims that were improperly denied, in
whole or in part, because of the noncompliance.
(2) THE COMMISSIONER MAY EXER CISE DISCRETION TO R EVIEW A
SUBSET OF NONQUANTIT ATIVE TREATMENT LIMI TATIONS FOR THE PURP OSES OF
THIS SECTION IF THE COMMISSIONER :
(I) AFTER THE REPORTING DEADLINES ESTABLISHE D UNDER
SUBSECTIONS (C) AND (F) OF THIS SECTION , IDENTIFIES THE NONQU ANTITATIVE
TREATMENT LIMITATION S THAT WILL BE REVIE WED BY THE COMMISSIONER ;
(II) DESCRIBES AND POSTS ON THE ADMINISTRATION ’S
WEBSITE THE CRITERIA USED TO IDENTIFY THE NONQUANTITATIVE TREA TMENT
LIMITATIONS THAT WILL BE REVI EWED EACH YEAR ;
(III) REVIEWS NONQUANTITAT IVE TREATMENT LIMITA TIONS
THAT HAVE THE GREATE ST EFFECT ON ACCESS TO MENTAL HEALTH AND
SUBSTANCE USE DISORD ER CARE;
(IV) REVIEWS THE SAME SUB SET OF NONQUANTITATI VE
TREATMENT LIMITATION S FOR EACH CARRIER REP ORT;
(V) REVIEWS NOT LESS THA N 10 NONQUANTITATIVE
TREATMENT LIMITATION S FOR EACH CARRIER R EPORT; AND
(VI) ISSUES A DETERMINATI ON IN ANY MATTER THA T
IMPLICATES PARITY ACT COMPLIANCE REGARD LESS OF WHETHER A
NONQUANTITATIVE TREATMENT LIMITATION AT ISSUE IN THE MATT ER HAS BEEN
REVIEWED UNDER THIS SECTION.
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(2) THE COMMISSIONER MAY REQU IRE CARRIERS TO COMP LETE
DATA TEMPLATES FOR A NONQUANTITATIVE TREA TMENT LIMITATION MOR E
FREQUENTLY THAN EVER Y 2 YEARS.
(j) (1) If the Commissioner finds that the carrier failed to submit a complete
report required under subsection (c) or (f) of this section, the Commissioner may:
(I) TAKE ACTION AUTHORIZ ED UNDER PARAGRAPH (2) OF THIS
SUBSECTION;
(II) IN ACCORDANCE WITH § 2–208 OF THIS ARTICLE , CHARGE
THE CARRIER FOR ANY ADDITIONAL EXPENSES INCURRED BY THE COMMISSIONER
TO REVIEW ADDITIONAL REPORTS;
(III) IMPOSE A PENALTY FOR EACH DAY THAT THE CA RRIER
FAILS TO SUBMIT INFO RMATION REQUIRED BY THE COMMISSIONER TO EVALU ATE
COMPLIANCE; OR
(IV) impose any penalty or take any action as authorized:
(1) 1. for an insurer, nonprofit health service plan, or any other
person subject to this section, under this article; or
(2) 2. for a health maintenance organization, under this article
or the Health – General Article.
(2) IF THE COMMISSIONER CANNOT M AKE A DETERMINATION THAT A
SPECIFIC CONDUCT OR PRACTICE IS COMPLIAN T WITH THE PARITY ACT BECAUSE
THE CARRIER FAILED T O PROVIDE A SUFFICIE NT COMPARATIVE ANALY SIS FOR A
NONQUAN TITATIVE TREATMENT L IMITATION, THE COMMISSIONER MAY :
(I) ISSUE AN ADMINISTRAT IVE ORDER REQUIRING THE
CARRIER OR AN ENTITY DELEGATED BY THE CAR RIER TO TAKE THE FOL LOWING
ACTION UNTIL THE COMMISSIONER CAN MAKE A DETERMINATION OF C OMPLIANCE
WITH THE PARITY ACT:
1. MODIFY THE CONDUCT O R PRACTICE AS SPECIF IED
BY THE COMMISSIONER ;
2. CEASE THE CONDUCT OR PRACTICE; OR
3. SUBMIT PERIODIC DATA RELATED TO THE CONDU CT
OR PRACTICE; OR
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(II) SUBJECT TO PARAGRAPH (3) OF THIS SUBSECTION ,
REQUIRE THE CARRIER TO PERFORM A NEW COMPARATIVE ANAL YSIS.
(3) THE COMMISSIONER MAY REQU IRE THE CARRIER TO E STABLISH
SPECIFIC QUANTITATIV E THRESHOLDS FOR EVI DENTIARY STANDARDS A ND
CONDUCT A NEW COMPAR ATIVE ANALYSIS FOR A NONQUANTITATIVE TREA TMENT
LIMITATION IF THE COMMISSIONER DETERMIN ES A CARRIER FAILED TO PROVIDE A
SUFFICIENT COMPARATI VE ANALYSIS BECAUSE THE CARRIER DID NOT :
(I) USE APPLICABLE QUANT ITATIVE THRESHOLDS F OR THE
EVIDENTIARY STANDARD ; OR
(II) PROVIDE A SPECIFIC , DETAILED, AND REASONED
EXPLANATION OF HOW THE CARRIE R ENSURES THAT THE F ACTORS FOR THE
NONQUANTITATIVE TREA TMENT LIMITATION ARE BEING APPLIED COMPAR ABLY
AND NO MORE STRINGEN TLY TO MENTAL HEALTH AND SUBSTANCE USE DI SORDER
SERVICES.
(4) SUBSECTION (I)(1)(III) OF THIS SECTION DOES NOT APPLY TO THE
FAILURE OF A CARRIER TO SUBMIT A COMPLETE REPORT.
(k) If, as a result of the review required under subsection [(i)(1)] (I)(1)(I) of this
section, the Commissioner finds that the carrier failed to comply with [the provisions of]
the Parity Act, [and] did not submit a compliance plan to adequately correct the
noncompliance, OR FAILED TO SUBMIT INFORMATION THAT IS REQUIRED TO
EVALUATE COMPLIANCE WITH THE PARITY ACT, the Commissioner may:
(1) issue an administrative order that requires:
(i) the carrier or an entity delegated by the carrier to cease the
noncompliant conduct or practice; [or]
(II) THE CARRIER OR AN EN TITY DELEGATED BY TH E CARRIER
TO CEASE THE IMPLEME NTATION OF THE NONQU ANTITATIVE TREATMENT
LIMITATION; OR
[(ii)] (III) the carrier to provide a payment that has been denied
improperly because of the noncompliance, INCLUDING A FAILURE TO PROVIDE
INFORMATION THAT DEM ONSTRATES COMPLIANCE ; [or]
(2) IMPOSE A PENALTY OF NOT LESS THAN $1,000 FOR EACH DAY IN
WHICH THE CARRIER FA ILS TO SUBMIT INFORM ATION REQUIRED BY TH E
COMMISSIONER TO EVALU ATE COMPLIANCE ; OR
Ch. 233 2024 LAWS OF MARYLAND
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[(2)] (3) impose any OTHER penalty or take any action as authorized:
(i) for an insurer, nonprofit health service plan, or any other person
subject to this section, under this article; or
(ii) for a health maintenance organization, under this article or the
Health – General Article.
(L) (1) A CARRIER SHALL HAVE T HE BURDEN OF PERSUAS ION IN
DEMONSTRATING THAT I TS HEALTH PLAN DESIGN AND APPLICATI ON OF A
NONQUANTITATIVE TREA TMENT LIMITATION COMPLIES WITH THE PARITY ACT:
(I) IN ANY REVIEW CONDUC TED BY THE COMMISSIONER
UNDER THIS SECTION ; OR
(II) IN ANY MATTER FILED WITH COMPLAINT INVESTIGAT ION OR
MARKET CONDUCT ACTIO N UNDERTAKEN BY THE COMMISSIONER THAT INVOLVES
THE APPLICATION OF T HE PARITY ACT.
(2) (I) A FAILURE OF A CARRIER TO SUBMIT COMPLETE PARITY
ACT COMPLIANCE INFORM ATION REQUIRED UNDER THIS SECTION OR IN
CONNECTION WITH A MATTER FILED WITH AN INVESTIGATION OR EXAMINATION BY
THE COMMISSIONE R SHALL CONSTITUTE N ONCOMPLIANCE WITH TH E PARITY ACT.
(II) SUBSECTION (I)(1)(III) OF THIS SECTION DOES NOT APPLY
TO A CARRIER THAT FA ILS TO SUBMIT COMPLE TE PARITY ACT COMPLIANCE
INFORMATION .
[(l)] (M) In determining an appropriate penalty under subsection (j) or (k) of this
section, the Commissioner shall consider the late filing of a report required under
subsection (c) or (f) of this section and any parity violation to be a serious violation with a
significantly deleterious effect on the public.
[(m)] (N) On or before December 31, 2021, the THE Commissioner shall create:
(1) a standard form for entities to submit the reports in accordance with
subsection (g)(1) of this section; and
(2) a summary form for entities to post to their websites in accordance with
subsection (g)(5) of this section.
[(n)] (O) On or before December 31, [2021] 2024, the THE Commissioner shall,
in consultation with interested stakeholders, adopt regulations to implement this section, WES MOORE, Governor Ch. 233
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including to ensure uniform definitions and methodology for the reporting requirements
established under this section.
15–1309.
(a) (1) In this section the following words have the meanings indicated.
(3) (i) “Product” means a discrete package of health benefits that are
offered using a particular product network type within a geographic service area.
(ii) “Product” comprises all plans offered within the product.
Chapter 211 of the Acts of 2020
[SECTION 2. AND B E IT FURTHER ENACTED, That the standard form the
Maryland Insurance Commissioner is required to develop under § 15–144(m)(1) of the
Insurance Article, as enacted by Section 1 of this Act, for the report required under §
15–144(c) of the Insurance Article, as enacted by Section 1 of this Act, shall be the National
Association of Insurance Commissioners’ Data Collection Tool for Mental Health Parity
Analysis, Nonquantitative Treatment Limitations and any amendments by the
Commissioner to the tool necessary to incorporate the requirements of § 15–144(c), (d), and
(e) of the Insurance Article, as enacted by Section 1 of this Act.]
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2020. [It shall remain in effect for a period of 6 years and, at the end of
September 30, 2026, this Act, with no further action required by the General Assembly,
shall be abrogated and of no further force and effect.]
Chapter 212 of the Acts of 2020
[SECTION 2. AND BE IT FURTHER ENACTED, That the st andard form the
Maryland Insurance Commissioner is required to develop under § 15–144(m)(1) of the
Insurance Article, as enacted by Section 1 of this Act, for the report required under §
15–144(c) of the Insurance Article, as enacted by Section 1 of this Act, shall be the National
Association of Insurance Commissioners’ Data Collection Tool for Mental Health Parity
Analysis, Nonquantitative Treatment Limitations and any amendments by the
Commissioner to the tool necessary to incorporate the requirements of § 15–144(c), (d), and
(e) of the Insurance Article, as enacted by Section 1 of this Act.]
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2020. [It shall remain in effect for a period of 6 years and, at the end of
September 30, 2026, this Act, with no further action required by the General Assembly,
shall be abrogated and of no further force and effect.]
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect July
1, 2024 is an emergency measure, is necessary for the immediate preservation of the public Ch. 233 2024 LAWS OF MARYLAND
– 16 –
health or safety, has been passed by a yea and nay vote supported by three–fifths of all the
members elected to each of the two Houses of the General Assembly, and shall take effect
from the date it is enacted.
Approved by the Governor, April 25, 2024.