Written by Ellen Weber and Dr. Laura Willing
Mr. Weber is senior vice president of health initiatives at Legal Action Center, and Mr. Willing is medical director of mental health policy and community mental health core advocacy at Children’s National Hospital.
Maryland currently has multiple opportunities during the 2024 legislative session to improve coverage and access to substance use and mental health care for individuals and families across the state.Above 2,500Marylanders lost to overdoses in 2023 alone; 922,000 An individual 12 years of age or older in the state who has a documented substance use disorder, and another person. 1,089,000 As someone who struggles with mental illness, the urgency is clear to me. We must act now to save lives!
Under state and federal parity laws, Marylanders have the right to health insurance coverage for drug use and mental health care and services on a nondiscriminatory basis. Essentially, equivalence laws require health plans to cover these services at the same level or at par with the benefits provided for other medical care and services.
In addition, insurance companies must certify that they offer such coverage by submitting reports certifying that the insurance plan meets these nondiscrimination standards.poignant report A document released by the Maryland Department of Insurance in late 2023 said no airlines in the state were in compliance. And some of Maryland’s largest airlines have already been fined nearly $1 million for these violations.
Without adequate reporting, states have no way to ensure that insurance companies are complying with the law. Meanwhile, insurers may unfairly deny authorization for substance use disorder or mental health care, provide inadequate reimbursement to in-network providers, or discourage providers from joining their networks in the first place. They get away with imposing onerous administrative requirements.
All this insurance talk may sound confusing, but it’s very simple. Marylanders’ lives are at risk when they are denied coverage for substance abuse disorder or mental health care, or when they cannot find a treatment provider that accepts their insurance. And Maryland’s young people are in even greater need of care, health leaders declared. National emergency in child and adolescent mental health In October 2021, we called for stronger enforcement of the Equality Act to improve the mental health of young people. Maryland lawmakers must heed this call to address these dangerous barriers to care.
We need to strengthen our state’s parity compliance reporting laws to hold health insurance companies accountable and ensure Marylanders get the care they need and deserve. Working closely with the Maryland Department of Insurance, advocates have helped pass the law (House Bill 1074/Senate Bill 684) This gives MIA the powers and strong oversight it needs to stop insurance companies from violating state and federal parity laws and end the deadly disparities in treatment that harm so many people and families. will be given.
Too many people are frustrated when they can’t find a doctor who will cover their opioid use disorder treatment without having to wait months or travel miles from home for an appointment. There are many. At a time when they are already dealing with the stress of health problems, people are forced to pay exorbitant out-of-pocket medical costs, which can cause financial hardship and instability. Urgently needed substance abuse disorder and mental health care can be dangerously delayed for youth as families try to navigate confusing and complex pre-authorization barriers, step therapy, and limited networks. The list goes on.
To close these gaps and improve access to and affordability of substance use and mental health care for all Marylanders, we are monitoring HB 1074/SB 684 and recommend the following: doing.
- Reporting and compliance verification is performed annually on a sufficient number of plan features to ensure consumers have fair coverage.
- State reporting law standards are consistent with federal law. This means that the information and data collected from state health plans, and the tools used to verify their compliance, must include what federal standards now and in the future detail. there is.
- Insufficient reporting will be treated as a parity violation, and a penalty provision has been adopted under which insurers who do not submit a complete compliance report must pay a fine for each day of incomplete reporting. At New York State’s request, the fines could be placed in a Parity Law Compliance Fund, which would help support further enforcement efforts, community education, and consumer assistance programs.
Insurance is complex, but it shouldn’t be about access to affordable, timely, and life-saving drug use and mental health treatment. Maryland now has an opportunity to advance important legislative changes that will make it easier for individuals and families across the state to get the care they need and deserve.
