Network Adequacy Regulations Information

Written submissions will be considered public documents and will be posted to the Maryland Insurance Administration website.

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General Information

 
Meeting Schedule and Agenda
 
Click HERE for a copy of House Bill 1318 Health Benefit Plans - Network Access Standards and Provider Network Directories
 
Click HERE for printer friendly version of Meeting Schedule and Agenda
 
Any questions or comments on Network Adequacy Regulations can be sent to: networkadequacy.mia@maryland.gov
 
To: Interested Parties
 
Pursuant to House Bill 1318 / Senate Bill 929, the Maryland Insurance Commissioner shall, in consultation with interested stakeholders, adopt regulations to establish quantitative and, if appropriate, non-quantitative criteria to evaluate a carrier’s network sufficiency.  These regulations must take effect by December 31, 2017. 
 
A Notice of Public Hearing on Regulations was published in the Maryland Register on April 29, 2016 advising that the first hearing on the above would take place on June 2, 2016. It also advised that an agenda would be posted prior to the first hearing on the Maryland Insurance Administration (MIA) website located at http://insurance.maryland.gov
 
Place: Maryland Insurance Administration, 22nd Floor Francis Scott Key Room, 200 St. Paul Place, Baltimore, MD 21202 and via conference call at 866-247-6034. Please enter the conference code 1573490062 when prompted.
 
Below please find the agenda for each meeting.
 
June 2, 2016 10:00 A.M. – 12:00 P.M.
Topics to be discussed:
• Any standards adopted by the Federal Centers for Medicare and Medicaid Services. §15-112(D)(2)(X)
• Any standards used by the federally facilitated marketplace. §15-112(D)(2)(X)
• Any standards adopted by another state. §15-112(D)(2)(XI)
 
July 14, 2016 10:00 A.M. – 12:00 P.M.
Topics to be discussed:
• Geographic accessibility of primary care and specialty providers, including mental health and substance use disorder providers. §15-112(D)(2)(I)
     o Should separate geographic accessibility standards be developed for certain specialists?
     o Should certain sub-specialties be treated separately from the general specialty?
• Geographic variation and population dispersion. §15-112(D)(2)(V)
 
August 4, 2016 10:00 A.M. – 12:00 P.M.
Topics to be discussed:
• Waiting times for an appointment with participating primary care and specialty providers, including mental health and substance use disorder providers. §15-112(D)(2)(II)
• Hours of operation. §15-112(D)(2)(VI)
• Other health care service delivery system options including telemedicine, telehealth, mobile clinics, and centers of excellence. §15-112(D)(2)(VIII)
 
September 1, 2016 10:00 A.M. – 12:00 P.M.
Topics to be discussed:
• Primary care provider-to-enrollee ratios. §15-112(D)(2)(III)
• Provider-to-enrollee ratios, by specialty. §15-112(D)(2)(IV)
• Should ratios be modified for providers who contract with more than one carrier?
• Should ratios be modified based on characteristics of the health benefit plan, such as having providers in centralized offices, or requiring a visit to a primary care provider for a referral?
 
October 6, 2016 10:00 A.M. – 12:00 P.M.
Topics to be discussed:
• The ability of the network to meet the needs of enrollees, which may include:
     o low-income individuals;
     o adults and children with serious, chronic, or complex health conditions or physical or mental   disabilities; and 
     o individuals with limited English proficiency or illiteracy. §15-112(D)(2)(VII)
 
November 3, 2016 10:00 A.M. – 12:00 P.M.
Topics to be discussed:
• The volume of technological and specialty care services available to service the needs of enrollees requiring technologically advanced or specialty care services. §15-112(D)(2)(IX)
• Other health care service delivery system options, including telemedicine, telehealth, mobile clinics, and centers of excellence. (repeat based on relevance to agenda topic). §15-112(D)(2)(VIII)
 
December 1, 2016 10:00 A.M. – 12:00 P.M.
Topics to be discussed:
• Identification of parts of the access plan that may be considered confidential by the carrier. §15-112(C)(3)(II)
• Additional testimony on previously discussed topics.
 
January 5, 2017 10:00 A.M. – 12:00 P.M.
Topics to be discussed:
• Standards for dental services. §15-112(E)
• Additional testimony on previously discussed topics.
 
February 2, 2017 10:00 A.M. – 12:00 P.M.
Topics to be discussed:
• Additional testimony on previously discussed topics. 

Resources From Other States

Hearing Testimony

 

MIA Staff Questions To Interested Parties

 

QUESTION (November 28, 2016)

At our September 1, 2016 meeting we discussed the following:
 
Provider-to-enrollee ratios, by specialty; whether ratios should be modified for providers who contract with more than one carrier; and whether ratios should be modified based on characteristics of the health benefit plan, such as having providers in centralized offices, or requiring a visit to a primary care provider for a referral.
 
The California Code of Regulations, 10 CCR § 2240.1(b)(1), states the following:
 
In arranging for network provider services, insurers shall ensure that:
 
(1) Network providers are duly licensed or accredited and that they are sufficient in number, capacity, and specialty to be capable of furnishing the health care services covered by the insurance contract, taking into account the number of covered persons, their characteristics and medical needs including the frequency of accessing needed medical care within the prescribed geographic distances outlined herein and the projected demand for services by type of services. If a network provider does not provide a service otherwise within the provider’s scope of practice covered under the insurance contract, the insurer shall ensure that there are sufficient providers in the network to provide that service. Subdivision (e) of this section shall apply if no providers in the network provide that service. (Emphasis added.)
 
MIA staff would appreciate your comments on the following:
 
• If quantitative standards for provider-to-enrollee ratios by specialty are established, should the ratios account for (a) geographic region, and (b) the fact that certain specialists do not perform every service otherwise within the specialist’s scope of practice?  If so, how should a carrier be required to account for this? 
• Should a specialist only be counted if he or she performs the top five, ten, etc. procedures normally provided by providers in that specialty?
• How should the carrier or MIA determine the most common procedures?
• Is there a better way to quantify the number of specialists capable of furnishing health care services covered by the health insurance contract?
 
Please email your answers and comments to: networkadequacy.mia@maryland.gov
 
The Deadline for comments is our last scheduled monthly network adequacy meeting.
 

QUESTION: (November 7, 2016)

The Maryland Insurance Administration has heard from several people that metrics based on numbers per population of members is not an effective way to measure access to care. What other ways might the MIA develop quantifiable criteria if metrics (such as x number of specialty providers per x number of members) are not used?

Please email your answers and comments to: networkadequacy.mia@maryland.gov

The Deadline for comments is our last scheduled monthly network adequacy meeting.


QUESTIONS: (August 1, 2016)

In an effort to ensure the most effective use of time, MIA staff request that your verbal and written testimony address the topic listed on the agenda for each meeting.

On June 2, 2016, the agenda included a discussion of standards adopted by another state. §15-112(D)(2)(XI). The laws and regulations enacted by Colorado, Washington, and California were identified as models by various speakers. Please address, for this agenda topic, the following questions:

Which specific standards or practices from these states do you believe will benefit Maryland, and why?
 
Which specific standards or practices from these states do you believe will not benefit Maryland, and why?
 
Are there specific standards or practices from any other states that you believe will benefit Maryland, and why?
 
Are there specific standards or practices from any other states that you believe will not benefit Maryland, and why?
 
Please email your answers and comments to: networkadequacy.mia@maryland.gov
 
The Deadline for comments is our last scheduled monthly network adequacy meeting.

 

QUESTION: (July 13, 2016)

Should Maryland follow the network adequacy standards required of carriers participating on the federal exchange? Why or why not?

Please email your answers and comments to: networkadequacy.mia@maryland.gov

The Deadline for comments is our last scheduled monthly network adequacy meeting.

Outside Reports and Studies

 
The documents in this folder contain reports, studies, and other information created and maintained by other public and private organizations. Please be aware that the MIA does not control or guarantee the accuracy, relevance, timeliness, or completeness of this outside information. Further, the inclusion of hypertext is not intended to reflect their importance, nor is it intended to endorse any views expressed or products or services offered by the author of the reference or the organization operating the site on which the reference is maintained.​ 

Draft Regulations

 

​Title 31 Maryland Insurance Administration
Subtitle 10 Health Insurance - General
31.10.44 Network Adequacy
Click to view the DRAFT REGULATIONS

Please submit your comments by close of business on May 8, 2017. Comments may be submitted electronically to networkadequacy.mia@maryland.gov or by regular mail to:
  

      Lisa Larson, Assistant Director of Regulatory Affairs
      Maryland Insurance Administration
      200 St. Paul Place, Suite 2700
      Baltimore, MD 21202

Comments Received in response to Draft Regulations

Proposed Regulations

 

Title 31 Maryland Insurance Administration
Subtitle 10 Health Insurance - General
31.10.44 Network Adequacy
Click HERE to view the Proposed Regulations

Comments Received in response to the Proposed Regulations

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