Acting on complaints from the health insurance industry, a Baltimore Circuit Court judge yesterday delayed a new state law that requires greater insurance coverage for mental illnesses.
Citing concerns about the law's wording, Judge Thomas Ward issued an emergency injunction staying it for 10 days.
Another hearing will be scheduled next week to decide whether to strike down or further delay the controversial law, which was due to go into effect tomorrow. But the dispute may have to be pTC resolved by the state legislature, which had wanted to eliminate disparities between insurance coverage for mental illnesses and other diseases.
"The intent of the law is clear, but it's the way [legislators] went about it and how they said it that's giving me trouble," Judge Ward said.
Lawyers for a coalition of insurance companies and health maintenance organizations, which had failed to block the legislation or get it vetoed earlier this year, complained yesterday that the law is unworkable because it is incomprehensible.
It requires that insurers provide mental-illness coverage on a par with the "majority of comparable benefits" available for any other type of health care.
Industry lawyers argued that that language is too vague, given the variety and complexity of health insurance plans now on the market.
"We have to know what we're going to offer and what we can charge," said Charles S. Fax, a lawyer for the industry. Without clear guidelines, he warned, insurance companies and HMOs could be driven to insolvency by lawsuits demanding "infinite" treatment of mental illnesses.
Citing a state memo indicating there should be no limits on outpatient treatment for mental illnesses, Mr. Fax said: "That's five days a week, one hour on the couch, forever."
BAt the least, he said, the law ought to be delayed until the state can issue regulations spelling out just what mental health coverage must be offered.
He also pleaded for more time to implement a provision in the law allowing people to refuse, or waive, the more generous but more costly mental health coverage.
Dennis W. Carroll, an assistant attorney general, acknowledged that HMOs deserve a reprieve because the law requires the state insurance commissioner to determine what mental health benefits they must offer. But he argued that the law clearly puts the burden on other insurance companies to figure out how to eliminate disparities in health benefits.
And he pointed out that a legislative oversight committee had refused earlier this month, after complaints from insurers, to approve emergency regulations spelling out mental-illness benefits.
State Insurance Commissioner Dwight K. Bartlett III said he would seek to address the industry's concerns by revising the rules that were held up by the legislative panel. But he predicted that reissuing the regulations could take several weeks or months, given legal requirements for public comment and hearings.
Mr. Bartlett also said he suspected that the insurance industry's real motive in going to court was to buy time until it could get the legislature to change or repeal the law.
But Bryson Popham, another industry lawyer, replied: "Our clients are willing to comply with the law if they know what it requires."
Mental health advocates expressed disappointment with the delay, but pledged to seek some compromise with the industry on a law that they said contained elements that also displeased them.
"I don't really think it's as confusing as they make it out to be," said Linda Raines, executive director of the Mental Health Association of Maryland. "If they wanted to figure it out, they could."
Mental health advocates would like to eliminate the provision allowing people to refuse better mental-illness benefits, since the fewer the people that choose them, the higher the premiums. The waiver provision was added at the behest of some insurance interests who oppose mandated benefits.
Del. Virginia M. Thomas, the Howard County Democrat who sponsored the legislation in the House, said she and other legislators will try to mediate the disputes next month.