Network Adequacy Regulations Information

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


Any questions or comments on Network Adequacy Regulations can be sent to: networkadequacy.mia@maryland.gov

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Annual Filing

 

Annual Filing Instructions

Population Density by Zip Code

2020 Executive Summary Form Filings

Please note: the information contained in the executive summary forms provided below has not yet been reviewed by MIA staff for accuracy or completeness. The preliminary information reported below may be subject to change after the MIA completes its review of the 2020 access plans.

Aetna Health and Life Insurance Company
Aetna HMO
Aetna PPO
CareFirst of Maryland Access Plan
CareFirst BlueChoice Access Plan
Cigna Health and Life Insurance Co.
Connecticut General Life Insurance Co.
Golden Rule Insurance Company
Group Hospitalization Medical Services Access Plan
Kaiser Foundation of the Mid-Atlantic States
KPIC 2020 Network Adequacy Access Plan
MLH Choice-ChoicePlus
Nexus ACO
OCI
UHCMA Choice-ChoicePlus
UHCMA Core
UHCMA Navigate
UHIC Choice-ChoicePlus
UHIC Core
UHIC Navigate
UHIC Navigate CVS
UHIC Options PPO
Well Fleet

2019 Executive Summary Form Filings

2018 Executive Summary Form Filings

2020 Meeting Schedule

 

​Next Meeting

The next public meeting to discuss potential revisions to the network adequacy regulations under COMAR 31.10.44 will be held virtually:
 
August 5, 2020, from 10:00 AM to 12:30 PM
Agenda
 
The Administration continues to solicit information from interested parties on whether the current filing process and existing standards are sufficient, appropriate and reasonable. Individuals or organizations who wish to submit written testimony should submit it to networkadequacy.mia@maryland.gov. We anticipate that the August 5, 2020 meeting will be the final meeting of the workgroup, and the deadline for submission of written comments is August 19, 2020.


Previous Meetings

April 20, 2020
Agenda

December 18, 2019
Agenda

November 5, 2019
Agenda

October 23, 2019
Agenda

2019-2020 MIA Staff Questions To Interested Parties

 
The Maryland Insurance Administration is accepting comments on all aspects of the network adequacy regulations in COMAR 31.10.44. In addition to the questions posed in the October 23, 2019 meeting agenda, MIA staff would appreciate comments on the following:
 
In the definitions section in COMAR 31.10.44.02, should a definition for any of the provider types listed in the travel distance standards be included?
 
Do the charts of travel distance standards in COMAR 31.10.44.04 include the appropriate mix of providers?  Should any providers be added (e.g. child psychiatrist) or removed, and why?
 
Are the current mileage metrics for the travel distance standards in COMAR 31.10.44.04 appropriate?
 
Should carriers be required to comply with the travel distance standards for 100% of enrollees, or should the threshold be 95% to be consistent with the appointment waiting time standards, and why?
 
Should the regulations be revised to require that travel distance standards are based on “road travel distance”? Why or why not?
 
For enrollees covered under student health plans, should the regulations mandate or allow that the school’s address be used for determining travel distance standards?
 
For the essential community provider standard, COMAR 31.10.44.04C requires that a provider panel “shall include 30 percent of the available essential community providers in each of the urban, rural, and suburban areas.”
 
Should the regulation be revised to require a standardized methodology for calculating the 30% inclusion standard by geographic region?
 
Should carriers be required to provide a list of all contracted ECPs within their network for each provider panel?
 
Should the regulations require a standardized methodology to measure wait time standards, and if so, what methodology?
 
Are the current time period metrics for the waiting time standards in COMAR 31.10.44.05 appropriate based on the availability of healthcare providers in Maryland?
 
The Following Two Questions have been Added Effective December 3, 2019
 
House Bill 599 of the 2019 legislative session, effective January 1, 2020, requires carriers to use the most recent edition of the American Society of Addiction Medicine treatment criteria (“ASAM criteria”) for all medical necessity and utilization management determinations for substance use disorder benefits.  Are revisions to the network adequacy regulations in COMAR 31.10.44 necessary to ensure that a carrier’s network is sufficient to provide coverage at all levels of care indicated by the ASAM criteria?  If so, what specific standards or metrics should be established based on the ASAM criteria?

It has been noted that the definition of “essential community provider” in the plan certification regulations for the Maryland Health Benefit Exchange expressly includes school-based health centers, but the corresponding definition in the network adequacy regulations for the Maryland Insurance Administration does not.  Are there any potential adverse consequences for consumers or significant carrier concerns with revising the essential community provider definition in COMAR 31.10.44.02B(6) to expressly include school-based health centers?
 
Please note that the deadline for the submission of written comments is August 19, 2020.

2019-2020 Hearing Testimony

 
  • View comments submitted by the Maryland Psychiatric Society January 22, 2020.
  • View comments submitted by the Maryland Assembly on School-
    Based Health Care January 19, 2020 
  • View comments submitted by American Psychiatric Association January 13, 2020.
  • View comments submitted by Maryland Academy of Nutrition and Dietetics December 18, 2019.
  • View comments submitted by Legal Action Center December 19, 2019.
  • View comments submitted by Community Behavioral Health Association of Maryland December 12, 2019.
  • View comments submitted by Maryland Assembly on School-Based Health Care November 12, 2019.
  • View comments submitted by Maryland Society of Pathologists November 4, 2019.

2016-2017 Workgroup

 
  • ​2016-2017 Network Adequacy Regulations Page
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