Network Adequacy Part V: Proposed Regulations a Win for Behavioral Health Consumers
You may remember from Part IV of our Network Adequacy series that the Maryland General Assembly passed landmark legislation in 2016 requiring that health insurance plans in the state have adequate numbers of providers in their networks to ensure that behavioral health consumers can access timely care. This legislation, enacted after years of advocacy with state regulators and decision-makers, required the Maryland Insurance Administration (MIA) to promulgate new regulations by 2018 to implement the law for plans beginning in 2019.
We are excited to share that the proposed regulations are a huge win for privately-insured behavioral health consumers. Throughout the past year, the MIA held public hearings on various topics relevant to network adequacy. MHAMD and other healthcare consumer advocacy organizations worked together to submit comments and testimony with a singular message: privately insured Marylanders deserve timely access to care and the only way to ensure that is by holding the insurers accountable to meet appointment wait time standards. The MIA agreed; the proposed regulations not only include geographic standards (travel distances), but they also include some of the strongest appointment wait time standards in the country.
While the regulations aren’t perfect and they aren’t yet final, they provide strong network adequacy requirements and consumer protections. The regulations require insurance carriers:
- Have enough providers within a geographic area to ensure that consumers can access appointments within:
- 10 days for non-urgent behavioral health care
- 15 days for primary care
- 72 hours for emergency behavioral health care
- Have providers within a specific distance of a member’s home or workplace depending on their geographic area:
- 10 miles for urban areas
- 25 miles for suburban
- 60 miles for rural areas
- Have one mental health and one substance use disorder provider for every 2000 members, and
- Make available an executive summary explaining how they reached network sufficiency
MHAMD joined a number of our partner organizations in submitting comments to point out a few of the concerns remaining, mainly that insurers can apply for a waiver of the requirements and that there is no limit to the number of times they can apply for the waiver. We hope the MIA addresses these concerns and upholds all the strong protections in the final regulations, which should be published later this fall. Check back on the blog or subscribe to our email list for updates.
Network Adequacy Series Posts