Maryland has been hard hit by the devastating opioid epidemic, tragically losing 2,009 of its residents to overdoses last year alone. Addiction and the mental illness that often accompanies it are complex health problems, best addressed with treatment and recovery services of proven effectiveness. Yet for too many people seeking treatment, needed care is inaccessible due to insurance barriers, including a lack of in-network providers and denials of coverage.
These barriers to care are not only discriminatory, they are often illegal under federal and state laws.
This is an issue about which we both care deeply. In the 1990s, we worked together to expand access to drug treatment and to advance federal legislation providing for non-discriminatory insurance coverage for mental illnesses, including addiction. The bill we championed in those years eventually became law exactly 10 years ago, as the Mental Health Parity and Addiction Equity Act of 2008.
The Parity Act, designed to end discrimination against people with mental health and substance use disorders, requires most health plans to cover services for mental health and substance use disorders at the same level as other medical services. This means it is illegal for health plans to impose barriers — higher deductibles, burdensome authorization requirements, limited provider networks — on people seeking treatment for addiction or mental illness that are not imposed when care is sought for other medical conditions.
We want to be sure this federal law is vigorously enforced in Maryland. In December, building on the Parity Act, our state adopted some of the strongest standards in the nation to help Marylanders access addiction treatment. The Maryland Insurance Administration (MIA) established “network adequacy” standards — minimum requirements for insurance carriers to have sufficient availability of in-network providers. If fully implemented, Marylanders should have access to in-network treatment providers when and where they need them: nearby and without excessive wait times.
The first round of data is in. So how did the insurance carriers do? Not very well.
Only one of 13 insurance carriers reported having sufficient mental health and substance use providers in its network this year to ensure access to non-urgent services within 10 days, as required by law.
In light of these gaps, the MIA should require corrective actions from non-compliant carriers. Insurance plans must open their networks to mental health and substance use providers and offer those providers fair reimbursement. The MIA also must ask carriers to demonstrate that their authorization rules for addiction and mental health services are no more restrictive than rules for other medical services.
Finally, when Marylanders cannot access treatment services within the time set by state law, they should be permitted to get services from a non-network provider and pay no more than they would pay for in-network care. Maryland currently allows providers to bill consumers at higher rates for out-of-network care. That should be impermissible.
In the face of a horrific and enduring public health crisis, we need to leverage every solution available. Full enforcement of the federal Parity Act in Maryland is attainable and essential.