On April 26, 2016, Governor Hogan signed HB1318-Health Benefit Plans-Network Access Standards and Provider Network Directories into law. This landmark legislation based on the National Association of Insurance Commissioners (NAIC) Network Adequacy Model Act will dramatically improve insured Marylanders’ ability to use their health insurance to access care. The legislation enables the Maryland Insurance Administration (MIA) to enforce network adequacy requirements. The MIA will promulgate and enforce regulations with real standards, such as limits on travel requirements and wait times for appointments. The legislation also requires the insurance carriers to improve the accuracy of the directories – no longer should there be retired doctors or wrong numbers in the online directories members use to make appointments. The insurers must also provide information to members about how they can request to see an out of network provider at the same out of pocket cost as an in-network doctor, allowing them more timely and affordable appointments.
Maryland advocates, including MHAMD, worked tirelessly through the Maryland General Assembly session to ensure the passage of this legislation, but our work isn’t over. The MIA has begun the work of drafting regulations, holding monthly hearings to allow stakeholders to provide feedback on the suggested topics. The first hearing on June 9, 2016 focused on other state and federal standards that Maryland could consider adopting. MHAMD and other consumer advocates pressed the MIA to strongly consider the Medicare Advantage standards and to look at the states that have most recently updated their standards. These states have added maximum wait times that members can be expected to wait for appointments for primary and specialty care providers. The next meeting will be held July 14, 2016, and will focus on a topic of much importance to behavioral health consumers: geographic accessibility of specialty providers.
We need your help! As we draft our comments and testify at each hearing to ensure strong regulations are adopted, we need your stories! Please contact us with any examples of having difficulty finding a behavioral health provider who accepts your insurance and is available for a timely appointment. We would love to have you share them with the MIA at the hearing, but if you aren’t able to attend, we can share them on your behalf. It is important that the Commissioner and the MIA staff hear how inadequate networks have affected you and your family.
Network Adequacy Series Posts
Network Adequacy Series, Part III: What Maryland advocates are doing
Network Adequacy Series, Part II: What are state and federal regulators doing about it?