Parity is about fairness. Americans with behavioral health conditions often have more difficulty getting the treatment and services they need when compared to individuals seeking other medical care. Explore parity-related information regarding legislation, statutes, and regulatory actions since the Federal Parity Law was passed in 2008.
Maryland Parity Law
There is a section of the state insurance law relevant to parity for behavioral health coverage and another section about coverage for autism and other developmental disorders.
Behavioral Health Coverage
Maryland Insurance law requires large employer fully-insured plans,small employer fully-insured plans, and individual plans to provide coverage for behavioral health services under the “same terms and conditions” as other medical services with no exempted conditions.
This Section requires plans to comply with certain sections of the Federal Parity Law, including those that address financial requirements,quantitative treatment limitations, and non-quantitative treatment limitations (NQTLs).
The law states that plans must cover the following services for behavioral health treatment at the same level as they cover these services for other medical treatment:
- Inpatient care
- Partial hospitalization (no less than 60 days, no matter what is in place for other medical care)
- Outpatient care
This section requires that “Processes, strategies, evidentiary standards, or other factors used to determine coverage” for behavioral health coverage cannot be “applied more stringently” than they are for other medical coverage. Generally speaking that would mean NQTLs like prior authorization,medical necessity determinations, and other forms of utilization review.
This section states that if managed care is not used for physical health coverage, it can’t be used for behavioral health coverage.
This section mandates that a copayment for methadone maintenance can’t be more than 50% of its daily cost.
Plans are also required to notify enrollees of the requirements of this section and the Federal Parity Law.
Maryland law requires individual plans,small employer fully-insured plans, and large employer fully-insured plans to cover habilitative services for autism and a number of other developmental disorders through age 18.
Habilitative services are defined as occupational therapy, physical therapy, and speech therapy.
This section requires plans to provide these services “in accordance with regulations adopted by the Commissioner” of the Maryland Insurance Administration.