HEALTH INSURANCE
Tom Killmond, PA-C
Major Reform Proposals
House Bill 754 (failed) would have expanded eligibility for Medicaid and the Maryland Children’s Health Program (MCHP) and continued coverage for adult child dependents. These efforts would have been funded by a $1.00 increase in the tobacco tax, savings from hospital uncompensated care, and the transfer of funds from the Maryland Health Insurance Plan Fund and the Maryland Health Care Provider Rate Stabilization Account and Fund. The Administration’s proposal, Senate Bill 149/House Bill 132 (both failed), would have expanded access to MCHP, established a Maryland Health Care Quality Coordinating Council, and created a Task Force on Expanding Access to Affordable Health Care. A study on establishing a health insurance exchange also would have been required.
Continuation of Coverage for Child Dependents
Generally, children are allowed to remain on the policy of a parent until age 19 or until age 23 if the child is a full-time student. However, after reaching the limiting age of the policy, many young adults lose access to insurance. Several bills sought to continue coverage by allowing a “child dependent” to remain on an insured’s policy beyond the limiting age of the plan. Under House Bill 1057 (passed), insurers, nonprofit health service plans, and health maintenance organizations must allow a child dependent to remain on an insured’s plan until age 25.
Access to Coverage for Domestic Partners
House Bill 1057 (passed) also requires individual and group health insurance policies and contracts that allow family coverage to provide, at the request of an insured or group policy holder, the same benefits and eligibility guidelines that apply to other covered dependents for a domestic partner or the child dependent of a domestic partner of the insured.
Relationship Between Health Insurance Carriers and Health Care Providers
Several bills were considered by the General Assembly this session that addressed the contracting relationship between health insurance carriers and health care providers. The bills largely result from a perceived imbalance in the negotiating power between carriers and providers, particularly as carriers have merged and a small number of carriers dominate the insurance market. Senate Bill 107 (passed) establishes a Task Force on Health Care Access and Reimbursement.
The task force must study reimbursement rates and total payments to health care providers; the impact of changes in reimbursement on access to health care, health care disparities, volume of services, and quality of care; the effect of competition on payments to health care providers; trends for health care provider shortages; the amount of uncompensated care provided by health care providers and trends in uncompensated care; the extent to which current reimbursement methods recognize and reward higher quality of care; methods used by large purchasers of health care to evaluate adequacy and cost of provider networks; and the practice by certain carriers of requiring providers who join a provider network to also serve on the provider network of a different carrier.
Non-Physician Specialist Referrals
Senate Bill 263/House Bill 519 (both passed) require health insurance carriers to establish and implement a procedure by which a member may request a referral to a non-physician specialist who is not part of the carrier’s provider panel if the carrier cannot provide reasonable access to a non-physician specialist with the expertise needed to treat a condition or disease. A non-physician specialist is defined as a health care provider who (1) is not a physician; (2) is licensed or certified under the Health Occupations Article; and (3) is certified or trained to treat or provide health care services for a specified condition or disease in a manner that is within the scope of the license or certification of the health care provider.
Reimbursement for Psychiatric Treatment
Senate Bill 601/House Bill 947 (both passed) address the situation of health care providers, particularly psychiatrists, who work primarily in private practice but also see patients in clinics. Although the provider may have negotiated a fee schedule with a health insurance carrier for treating patients in the private practice, the carrier may pay the provider at the lower clinic rate. The lower reimbursement is a disincentive for providers to practice in clinics, where indigent patients often receive care.