Maryland Statutes
Subtitle 8 - Required Health Insurance Benefits
Section 15-802 - Benefits for Treatment of Mental Illnesses, Emotional Disorders, and Drug and Alcohol Misuse

(a)    (1)    In this section the following words have the meanings indicated.
        (2)    “Alcohol misuse” has the meaning stated in § 8–101 of the Health – General Article.
        (3)    “ASAM criteria” means the most recent edition of the American Society of Addiction Medicine treatment criteria for addictive, substance–related, and co–occurring conditions that establishes guidelines for placement, continued stay and transfer or discharge of patients with addiction and co–occurring conditions.
        (4)    “Drug misuse” has the meaning stated in § 8–101 of the Health – General Article.
        (5)    “Grandfathered health plan coverage” has the meaning stated in 45 C.F.R. § 147.140.
        (6)    “Health benefit plan” means:
            (i)    for a group or blanket plan, a health benefit plan as defined in § 15–1401 of this title;
            (ii)    for an individual plan, a health benefit plan as defined in § 15–1301(l) of this title; or
            (iii)    short–term limited duration insurance as defined in § 15–1301(s) of this title.
        (7)    “Managed care system” means a system of cost containment methods that a carrier uses to review and preauthorize a treatment plan developed by a health care provider for a covered individual in order to control utilization, quality, and claims.
        (8)    “Partial hospitalization” means the provision of medically directed intensive or intermediate short–term treatment:
            (i)    to an insured, subscriber, or member;
            (ii)    in a licensed or certified facility or program;
            (iii)    for mental illness, emotional disorders, drug misuse, or alcohol misuse; and
            (iv)    for a period of less than 24 hours but more than 4 hours in a day.
        (9)    “Small employer” has the meaning stated in § 31–101 of this article.
    (b)    With the exception of small employer grandfathered health plan coverage, this section applies to each individual, group, and blanket health benefit plan that is delivered or issued for delivery in the State by an insurer, a nonprofit health service plan, or a health maintenance organization.
    (c)    A health benefit plan subject to this section shall provide at least the following benefits for the diagnosis and treatment of a mental illness, emotional disorder, drug use disorder, or alcohol use disorder:
        (1)    inpatient benefits for services provided in a licensed or certified facility, including hospital inpatient and residential treatment center benefits;
        (2)    partial hospitalization benefits; and
        (3)    outpatient and intensive outpatient benefits, including all office visits, diagnostic evaluation, opioid treatment services, medication evaluation and management, and psychological and neuropsychological testing for diagnostic purposes.
    (d)    (1)    The benefits under this section are required only for expenses arising from the treatment of mental illnesses, emotional disorders, drug misuse, or alcohol misuse if, in the professional judgment of health care providers:
            (i)    the mental illness, emotional disorder, drug misuse, or alcohol misuse is treatable; and
            (ii)    the treatment is medically necessary.
        (2)    The benefits required under this section:
            (i)    shall be provided as one set of benefits covering mental illnesses, emotional disorders, drug misuse, and alcohol misuse;
            (ii)    shall comply with 45 C.F.R. § 146.136(a) through (d) and 29 C.F.R. § 2590.712(a) through (d);
            (iii)    subject to paragraph (3) of this subsection, may be delivered under a managed care system; and
            (iv)    for partial hospitalization under subsection (c)(2) of this section, may not be less than 60 days.
        (3)    The benefits required under this section may be delivered under a managed care system only if the benefits for physical illnesses covered under the health benefit plan are delivered under a managed care system.
        (4)    The processes, strategies, evidentiary standards, or other factors used to manage the benefits required under this section must be comparable as written and in operation to, and applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used to manage the benefits for physical illnesses covered under the health benefit plan.
        (5)    An insurer, nonprofit health service plan, or health maintenance organization shall use the ASAM criteria for all medical necessity and utilization management determinations for substance use disorder benefits.
    (e)    An entity that issues or delivers a health benefit plan subject to this section shall provide on its website and annually in print to its insureds or members:
        (1)    notice about the benefits required under this section and the federal Mental Health Parity and Addiction Equity Act; and
        (2)    notice that the insured or member may contact the Administration for further information about the benefits.
    (f)    An entity that issues or delivers a health benefit plan subject to this section shall:
        (1)    post a release of information authorization form on its website; and
        (2)    provide a release of information authorization form by standard mail within 10 business days after a request for the form is received.

Structure Maryland Statutes

Maryland Statutes

Insurance

Title 15 - Health Insurance

Subtitle 8 - Required Health Insurance Benefits

Section 15-801 - Benefits for Alzheimer's Disease and Care of Elderly Individuals

Section 15-802 - Benefits for Treatment of Mental Illnesses, Emotional Disorders, and Drug and Alcohol Misuse

Section 15-803 - Payments for Blood Products

Section 15-804 - Coverage for Off-Label Use of Drugs

Section 15-805 - Reimbursement for Pharmaceutical Products

Section 15-806 - Choice of Pharmacy for Filling Prescriptions

Section 15-807 - Coverage for Medical Foods and Modified Food Products

Section 15-808 - Benefits for Home Health Care

Section 15-809 - Benefits for Hospice Care Services

Section 15-810 - Benefits for in Vitro Fertilization

Section 15-810.1 - Coverage for Standard Fertility Preservation Procedures

Section 15-811 - Hospitalization Benefits for Childbirth

Section 15-812 - Inpatient Hospitalization Coverage for Mothers and Newborn Children

Section 15-813 - Benefits for Disability Caused by Pregnancy or Childbirth

Section 15-814 - Coverage for Breast Cancer Screenings

Section 15-815 - Coverage for Reconstructive Breast Surgery

Section 15-816 - Benefits for Routine Gynecological Care

Section 15-817 - Coverage for Child Wellness Services

Section 15-818 - Benefits for Treatment of Cleft Lip and Cleft Palate

Section 15-819 - Coverage for Outpatient Services and Second Opinions

Section 15-820 - Benefits for Orthopedic Braces

Section 15-821 - Diagnostic and Surgical Procedures for Bones of Face, Neck, and Head

Section 15-822 - Coverage for Diabetes Equipment, Supplies, and Self-Management Training

Section 15-823 - Coverage for Osteoporosis Prevention and Treatment

Section 15-824 - Coverage for Maintenance Drugs

Section 15-825 - Coverage for Detection of Prostate Cancer

Section 15-826 - Coverage for Prescription Drugs

Section 15-826.1 - Coverage for Contraceptive Drugs and Devices

Section 15-826.2 - Coverage for Male Sterilization

Section 15-826.3 - Coverage for Fertility Awareness-Based Methods

Section 15-827 - Coverage for Patient Cost for Clinical Trials

Section 15-828 - Coverage for Charges Related to Dental Care

Section 15-829 - Coverage for Detection of Chlamydia

Section 15-830 - Referrals to Specialists

Section 15-831 - Coverage of Prescription Drugs

Section 15-832 - Coverage for Removal of Testicle

Section 15-832.1 - Inpatient Hospitalization Coverage Following Mastectomy

Section 15-833 - Extension of Benefits

Section 15-834 - Coverage for Prostheses

Section 15-835 - Required Coverage for Habilitative Services

Section 15-836 - Hair Prosthesis

Section 15-837 - Colorectal Cancer Screening Coverage

Section 15-838 - Hearing Aid Coverage for a Minor Child

Section 15-839 - Coverage for Treatment of Morbid Obesity

Section 15-840 - Coverage for Medically Necessary Residential Crisis Services

Section 15-841 - Coverage for Smoking Cessation Treatment

Section 15-842 - Copayment or Coinsurance for Prescription Drugs and Devices Limited

Section 15-843 - Coverage for Amino Acid-Based Elemental Formula

Section 15-844 - Benefits for Prosthetic Devices

Section 15-845 - Coverage for Refills of Prescription Eye Drops

Section 15-846 - Coverage for Cancer Chemotherapy

Section 15-847 - Coverage for Specialty Drugs

Section 15-847.1 - Copayment or Coinsurance Limits for Certain Drugs -- Annual Increase Regulated

Section 15-848 - Coverage for Ostomy Equipment and Supplies

Section 15-849 - Coverage for Abuse-Deterrent Opioid Analgesic Drug Products

Section 15-850 - Prior Authorizations for Opioid Antagonist

Section 15-851 - Prior Authorization for Drug Products to Treat Opioid Use Disorder -- Prohibition

Section 15-852 - Prorated Daily Copayment or Coinsurance Amount for Partial Supply of Prescription Drug

Section 15-853 - Coverage for Lymphedema Diagnosis, Evaluation, and Treatment

Section 15-854 - Prior Authorization for Prescription Drug

Section 15-855 - Coverage for Pediatric Autoimmune Neuropsychiatric Disorders

Section 15-856