As noted in the October issue, the Maryland Department of Health’s (MDH) preliminary compliance report required by the federal parity act overlooks a key aspect of parity: provider rates. Last month, the Maryland Parity at 10 Coalition, which includes the MPS, sent a letter to Secretary Neall noting key priorities, including the need for review of prior authorization and other utilization management requirements and the setting of reimbursement rates to ensure non-discriminatory standards. Pending the submission of MDH’s final compliance report, the coalition explained its concern regarding MDH’s assertion “that ‘the setting of provider rates falls outside the scope of MHPAEA parity requirements.’ In fact, federal regulations and guidance make crystal clear that the Parity Act governs the setting of reimbursement rates as a non-quantitative treatment limitation. 42 C.F.R. § 440.395(b)(4)(ii). We request that this compliance information be included in the final Parity compliance report.” The letter goes on to express interest in the MDH’s proposed rate-setting study while stating, “that study differs from a Parity Act analysis, which requires an assessment of the ‘processes, strategies, evidentiary standards, or other factors,’ as written and in operation, to ensure that they are comparable to and applied no more stringently to MH and SUD benefits than to medical/surgical benefits.”
The Maryland Parity at 10 Coalition will continue to work with MDH to ensure that the full potential of the law is realized in our state’s Medicaid and Children’s Health Insurance programs.