MPS Advocacy on Network Adequacy

In response to the Maryland Insurance Administration’s (MIA) draft proposed Network Adequacy Regulations, the MPS joined the Legal Action Center and 13 other organizations and individuals in submitting comments.  Highlights of the recommendations include:

  • We support gathering essential information on out-of-network (OON) utilization, most common OON utilization by provider type, single case agreements, telehealth utilization, and complaint data related to network provider access. This critical data should be made available to the Maryland General Assembly in aggregate data reports and through briefings to inform policy development and ensure transparency for the public as well as employers who seek accessible MH and SUD benefits for their workforce.
  • We appreciate retention of standards that would increase the granularity of data regarding MH and SUD provider/facility types and appointment types that carriers must report to the MIA and the public. We also support several newly proposed standards that will identify the availability of adolescent MH and SUD services. We, however, oppose proposed revisions to the Executive Summary that would remove identification of the appointment wait time values and the percentage of satisfaction for each appointment type.
  • We agree that telehealth services should be counted for satisfaction of appointment wait time and travel distance metrics, but we oppose the proposed telehealth standard that would remove enrollee election as a criterion for meeting such metrics. Patient needs and preferences must be at the center of all telehealth utilization decisions, which requires a direct accounting of enrollee election to assess network adequacy.
  • We appreciate the proposed requirement that carriers submit data to demonstrate “clinical appropriateness, availability and accessibility,” to claim the proposed telehealth credit, but we oppose the use of a “telehealth credit” to meet adequacy requirements until sufficient data are gathered to support a telehealth credit request. For purposes of enforcement, we also oppose the use of an artificial advantage to permit carriers to avoid penalties for maintaining inadequate networks. Additionally, the relationship between the use of a telehealth credit and the mandatory reporting of waiver standards in annual access plans is unclear.
  • Regardless of the process for counting telehealth utilization, carriers must be required to inform enrollees of their right to in-person services. The Preserve Telehealth Act of 2021 (SB 3) bars carriers from denying coverage for an in-person MH or SUD service solely because it may be covered through a telehealth benefit. Notification is the only way to enforce this right.

In addition to supporting the feedback above, the MPS offered two recommendations to strengthen the draft proposed Network Adequacy Regulations. The first relates to provider network directories, which continue to create confusion for consumers due to inaccuracies and inadequate detail. Many psychiatrists are credentialed for insurance coverage at an institution but do not participate in their private practice. Many of them continue to receive calls years after leaving hospital work or get calls at their office saying they’re listed as participating when they only do so in the hospital setting. When psychiatrists who do not participate except for inpatient care are included in a provider directory, it overstates the number available to consumers who need an outpatient appointment.  This leads to frustration as they call unsuccessfully a list of potential providers who are not participating in that setting.  The MPS suggested possible ways to address the shortcoming.

A second MPS concern relates to the conditions under which MIA may grant a waiver for the network adequacy requirements. The proposed language allows a carrier to request a waiver if they find that the measurement methodologies are “flawed.” However, because the carrier can claim that certain methodologies are confidential “proprietary information,” they could claim that the measurement methodology is flawed but not be required to publicly state how it was determined. The MPS suggested that MIA consider deleting this item or using alternative language.