New UR Criteria for SUD Benefits
On January 1, 2020 the Maryland Insurance Administration will implement new utilization review (UR) criteria requirements for substance use disorder (SUD) benefits as a result of House Bill 599, Chapter 358, Acts of 2019 – Utilization Review Criteria for Substance use Disorder Benefits.
The law requires carriers and Private Review Agents (PRA) to use the most recent edition of the American Society of Addiction Medicine treatment criteria for addictive, substance–related, and co–occurring conditions (“ASAM criteria”) for all medical necessity and utilization management determinations for SUD benefits. The ASAM criteria establish guidelines for placement, continued stay, and transfer or discharge of patients.
The uniform treatment plan (“UTP”) form will be modified to allow the PRA to request information when conducting UR of services for the treatment of a SUD.
The Maryland Behavioral Health Administration in partnership with ASAM will offer regional trainings that support the development of knowledge and skills required to implement the ASAM Criteria (updated Spring 2019), and provide updates and information for providers to proactively address the changes.
Click here for more info; call 410-468-2170 with questions.
Updated UTP Form
On January 23, 2015 the Maryland Insurance Commissioner proposed regulations in the Maryland Register to amend the Uniform Treatment Plan Form to: (1) remove out-of-date references to DSM-IV codes, which were replaced by DSM-5 codes in May 2013; and (2) expand the Uniform Treatment Plan Form to include more detail about the patient’s condition.
The proposed 3-page form was finalized effective May 11, 2015. The Maryland Insurance Administration site has a copy of the current form along with instructions.