During the summer of 2017, the Maryland Insurance Administration (MIA) summarized its second market conduct survey (MHP Survey Part II template) of insurance companies’ compliance with aspects of the Mental Health Parity and Addiction Equity Act (MHPAEA) in a letter to Senator Middleton. (Middleton Letter).  MIA reported that a number of issues were identified and corrected during its investigation; however it decided not to issue orders.  The issues involved violations such as medical necessity guidelines, in-network facilities for mental illness, site visit requirements associated with credentialing and prior authorization for scheduled admissions.  In addition, the MIA survey showed that some carrier networks were inadequate for patients needing treatment for opioid abuse and for bipolar disorder.

In August 2017, the MPS signed on to a response letter (Response Ltr MIA Summary Second Market Conduct Survey) regarding the second survey that was sent by a group of mental health advocates led by Ellen Weber of the Legal Action Center.  The group raises concern about the MIA decision to not issue orders to address serious gaps in network adequacy despite the problem persisting over three years with two of the carriers.  It also questions this decision being based in part on there not being proof of harm to patients resulting from the inadequacy.  The group notes that the second survey has taken over 18 months and is not yet complete for the predominant carriers, UnitedHealthcare and CareFirst.  It recommends a pre-market compliance tool along with four other steps to improve coverage and access to mental health and substance use disorder benefits in the commercial market:

• Provide a summary of quantitative data, for example on prescription drug coverage and fail first requirements, inpatient and residential treatment, etc.
• Disclose the carriers whose parity violations were corrected after being identified by the MIA. (The group vigorously contested the MIA conclusion that patients experienced no harm as a result of the violations.)
• Issue orders requiring corrective action and giving an incentive to improve compliance.
• Offer technical assistance to providers to improve network adequacy.

The letter also includes several attachments related to access to medications for treatment of substance use disorders. Click here: Middleton Letter to view the 14 page document.