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Date:​             May 27, 2026

To:                  Insurers, Nonprofit Health Service Plans, and Health Maintenance Organizations (“carriers")

Re:                 2026 Mental Health and Substance Use Disorder Analysis Reports and Data Reports

Section 15-144 of the Insurance Article, Annotated Code of Maryland [1] requires Maryland carriers to submit non-quantitative treatment limitation (“NQTL") reports to demonstrate compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“Parity Act").  The purpose of this bulletin is to provide Maryland carriers with updated filing guidance for the NQTL analysis reports required to be submitted in 2026 and to notify Maryland carriers of the filing extension from July 1, 2026, to September 1, 2026.

Due Date, Filing Instructions, and Data Supplements

The Maryland Insurance Administration (“MIA") has extended the deadline to file the NQTL reports for the 2026 reporting period from July 1, 2026, to September 1, 2026.  Carriers should submit the NQTL reports electronically to the MIA through an encrypted email sent to: [email protected]. 

In accordance with § 15-144(h), a carrier should annotate all information within the report that the carrier requests to be treated as confidential, and must provide the statutory authority under the Public Information Act that authorizes the denial of access to the information. 

The NQTL reports must be completed using only the forms and associated instructions developed by the Commissioner, which are posted on the MIA website under the heading “Mental Health and Substance Use Disorder NQTL Report."  Definitions of various terms used in this Bulletin, in current § 15-144, and in the template reporting forms are included in the MIA instructions and in Code of Maryland Regulations (“COMAR") 31.10.51.  Carriers should refer to applicable definitions when completing the required reports.  

In addition, in accordance with § 15-144(f), new standardized data templates have been developed to evaluate the comparative analysis of certain NQTLs selected by the Commissioner, in operation, and existing data templates have been revised.  Proposed data templates were posted to the MIA website, and comments were accepted for 30 days following the date of posting, which was March 18, 2026. 

After considering all of the comments received, the MIA posted the final instructions and data supplement templates to the MIA website (under the heading “Mental Health and Substance Use Disorder NQTL Reports"). Carriers must use the final instructions and data supplement templates to report their comparative analyses in 2026. The instructions provide that carriers base their comparative analyses on data from calendar year 2025. 

Please email the MIA at [email protected] if you need assistance in accessing the instructions or data supplement templates. 

The final instructions and data supplement templates are based on § 15-144 prior to amendment by recent legislation. On April 14, 2026, Maryland Senate Bill 205 [2] was enacted, which  amended § 15-144, effective July 1, 2026. Recognizing that the recent amendments to § 15-144 are not immediately effective and that carriers would not have collected data during calendar year 2025 specifically in a manner to comply with the new requirements, the MIA did not include those requirements in the instructions for the 2026 reporting period. 

In a footnote to the instructions provided by the MIA (entitled, “Mental Health Parity and Addiction Equity Act (MPHAEA), Compliance Reporting Instructions Non-Quantitative Treatment Limitations (NQTL), Seven Step Analysis"), there is a citation to Senate Bill 205 and its effective date, along with a sentence explaining that citations to § 15-144 within the document are as amended by Senate Bill 205. None of the requirements added to § 15-144 are referenced in the instructions and carriers are not instructed to comply with them as part of the finalized templates. Carriers should rely on § 15-144, prior to its amendment by Senate Bill 205, and the instructions provided by the MIA for the 2026 reporting period, which are based on § 15-144 prior to its amendment. 

The MIA encourages carriers to voluntarily share data required by § 15-144 as amended. Such data includes comparative analyses using the amended definitions of “mental health benefits" and “substance use disorder benefits," data on relevant outcomes related to access to mental health, substance use disorder, and medical/surgical benefits, and, with respect to NQTLs related to network composition, relevant data on the aggregate impact of all NQTLs on access to such benefits. The MIA will consider such data as part of a complete report. The failure alone to share such data will not be used as the sole basis for a determination of noncompliance or result in a penalty. 

Content of Reports

Each carrier subject to current § 15-144 must submit an NQTL report for each product offered by the carrier in the individual, small, and large group markets. Carriers are reminded that for the 2026 reporting period, it is no longer necessary to identify the five health benefit plans with the highest enrollment for each product and submit a separate report for each of those health benefit plans.  Instead, except as applicable under current 15-144(c)(4), NQTL reports should be completed at the product level.

Each NQTL report must include the results of a comparative analysis conducted by the carrier on the following five NQTLs that have been selected by the Commissioner for the 2026 reporting period in accordance with current § 15-144(c)(5):

​1. In-Network Provider (Including Facility) Reimbursement and Negotiations

2. Single Case Agreements/Network Gap Exceptions and Negotiations

3. Crisis and Emergency Services

4. Experimental/Investigational/Unproven Treatments

5. Medical Necessity Guidelines/Criteria

The report must be accompanied by a statement, signed by a corporate officer, attesting to the accuracy of the information contained in the report.  The statement must also attest that for each product, the NQTLs listed above, and the processes, strategies, evidentiary standards, or other factors used in designing and applying those NQTLs to mental health benefits, substance use disorder benefits, and medical/surgical benefits, are the same for all plans within the product, as written and in operation.  If the carrier is unable to provide this second attestation for any product, the carrier must note the exception(s) and must submit a separate comparative analysis and related data supplement for the applicable plans within that product that impose different NQTLs or use different factors.

Carriers are reminded that, even though the reports required to be filed by September 1, 2026, will include comparative analyses for only the five NQTLs identified above, current § 15-144(c)(1) requires each carrier to:

• Identify all NQTLs applied to benefits for mental health and substance use disorders;

• Perform and document comparative analyses of the design and application of all NQTLs imposed on benefits for mental health and substance use disorders; and

• Provide each comparative analysis to the Commissioner or a member upon request.