MIA issues corrective action orders against 5 carriers for noncompliance with parity law

Recently the Maryland Insurance Administration completed a market conduct investigation and issued corrective orders to five insurance carriers selling Qualified Health Plans on the Maryland Health Benefit Exchange for noncompliance with state and federal parity law; two of the five carriers were also assessed fines. While the orders are not considered final because the carriers have the right to appeal and request an administrative hearing, the issuance of these orders is a strong first step in holding the insurers accountable for compliance with federal and state parity laws.

While 2015 legislation requiring the carriers to demonstrate that they were compliant with the federal parity law was not successful, the MIA committed to performing market conduct surveys over a three-year period. These surveys will focus on nonquantitative treatment limitations, which are the most difficult to assess compliance during the MIA’s contract review because they are not always included in the contracts and documents submitted.

All of the corrective orders were related to network adequacy issues, which was one of the main concerns that consumers and providers testified to during the 2015 Maryland General Assembly Session. Most of the findings were that carriers were out of compliance with state and federal law in how they credentialed and determined reimbursement rates for mental health and substance use disorder providers. Two carriers admitted to not using similar formulas or policies in determining reimbursement rates for behavioral health and medical/surgical providers because they use a separate vendor to manage their behavioral health network and do not compare the policies or standards to their own.

One carrier was assessed a fine and required to take corrective action for having no in-network methadone treatment clinics and for having  more restrictive reimbursement rate setting policies and procedures for mental health and substance use disorder providers. Another carrier was fined for violation of Maryland’s credentialing statute and the parity laws- requiring any mental health provider who had been treated for substance abuse to have been sober for two years, which was not required of medical/surgical providers.

Year two survey further assessing carrier parity compliance was issued in early November. The Maryland Parity Project and its partners are encouraged by MIA’s willingness to assess parity compliance through surveys and enforce the nonquantitative requirements through corrective actions and fines. Check back here for updates on the appeals as the carriers’ hearings are scheduled. And don’t forget to contact us if you have any issues or concerns with your insurance company.

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