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31.10.51.00.htm 31.10.51.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 51 Mental Health Benefits and Substance Use Disorder Benefits ― Reports on Nonquantitative Treatment Limitations and Data Authority: Insurance Article, §2-109(a)1) and 15-144, Annotated Code of Maryland
31.10.51.01.htm 31.10.51.01. 01 Purpose.. The purpose of this chapter is to adopt regulations to implement Insurance Article, §15-144, Annotated Code of Maryland, to ensure uniform definitions and methodology for the reporting requirements established under this chapter.
31.10.51.02.htm 31.10.51.02. 02 Scope.. This chapter applies to carriers that deliver or issue for delivery a health benefit plan in Maryland.
31.10.51.03.htm 31.10.51.03. 03 Definitions.. A. In this chapter, the following terms have the meaning indicated.. B. Terms Defined.. 1) “Analysis report” means the report required by Insurance Article, §15-144(c) Annotated Code of Maryland.2) “As written” means the written policies, procedures, and related documents, including medical necessity criteria or guidelines, used in the development and description of a NQTL and the decision whether to apply a NQTL to a particular benefit by the carrier or any entity
31.10.51.04.htm 31.10.51.04. 04 Filing of Nonquantitative Treatment Limitation Comparative Analysis Report.. A. For the five health benefit plans with the highest enrollment for each product offered by the carrier in the individual, small, and large group markets, a carrier that delivers or issues for delivery a health benefit plan in the State shall file a comparative analysis for each nonquantitative treatment limitation specified in the form required by the Commissioner, to demonstrate the carrier’s c
31.10.51.05.htm 31.10.51.05. 05 Filing of Data Report.. A. For the five health benefit plans with the highest enrollment for each product offered by the carrier in the individual, small, and large group markets, a carrier that delivers or issues for delivery a health benefit plan in the State shall submit a data report for the immediately preceding calendar year for mental health benefits, substance use disorder benefits, and medical/surgical benefits by Parity Act classification.B. The data report shall
31.10.51.06.htm 31.10.51.06. 06 Summary Form.. A. A carrier subject to Insurance Article, §15-144, Annotated Code of Maryland, shall prepare a summary form using only the template form posted on the Administration’s website.B. The summary form shall be made available to plan members and accessible to the public on the carrier’s website no later than April 1, 2022 and April 1, 2024. The carrier shall make the summary form available to plan members in response to a written request within 30 days of the request.
31.10.51.07.htm 31.10.51.07. 07 Compliance Plan.. A. If, as a result of the review of the reports described in Regulations .02 and .03 of this chapter, the Commissioner finds that a carrier subject to Insurance Article, §15-144, Annotated Code of Maryland, failed to comply with provisions of the Parity Act, the Commissioner shall notify the carrier and require the carrier to submit a compliance plan pursuant to Insurance Article, §15-144(i) Annotated Code of Maryland, to correct the noncomplianc
31.10.51.08.htm 31.10.51.08. 08 Effective Date.. This chapter is applicable to all reports filed after January 1, 2022..
31.10.51.9999.htm 31.10.51.9999. Administrative History Effective date: Effective December 27, 2021 (48:26 Md. R. 1113).
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