Maryland health officials often tout the state's relatively low uninsured rate of 6%, but a new report finds that even the state's uninsured people have a significant impact on their overall well-being. It has been shown that patients may have difficulty obtaining insurance coverage for behavioral health services, which is an important factor.
A new report from a nonprofit research organization called RTI International finds that more people in Maryland seek out behavioral health professionals, such as psychiatrists and psychologists, than for most other medical services. It is highly likely that we will have to turn our attention to “.
Receiving services “out of network” means someone is receiving services or seeing a medical professional that are not covered by their insurance plan, which can result in significant costs. there is.
Ensuring that people have access to mental health services in the same way as general health services is a federal requirement under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
According to the federal Centers for Medicare and Medicaid Services (CMS), MHPAEA originally applied to group health plans, but the 2010 amendments to the Affordable Care Act extended the requirement to individual health plans. It is said that
The report, titled “Behavioral Health Equity – Widespread disparities in access to in-network care persist,” identifies similar services in traditional medical and surgical settings in Maryland and nationally. found that patients still struggle to access in-network behavioral health care compared to the United States. .
Using 2019-2021 data from “one of the largest commercial claims databases,” the report shows that individuals can easily receive in-network behavioral treatment as well as medical/surgical treatment. We assessed key measures of health insurance benefits that indicate access to health treatment. Use of out-of-network behavioral health providers. ”
They found that access to behavioral health services is not “equal” in most states.
“Patients were 3.5 times more likely (13.4% vs. 3.8%) to be out of network for all medical purposes for all behavioral health clinician office visits (i.e., physicians and nonphysicians combined). Physician Office Visits,” the report says of the national outlook.
The report continues:
“Patients are 6.9 times more likely to visit a psychiatrist (15.3% compared to 2.2%) and 8.2 times more likely to visit a psychologist (compared to 2.2%) than to see their primary care physician. I went outside.”
This trend continues with telehealth services, with patients 4.7 times more likely to go out-of-network for a telehealth visit with a behavioral health clinician compared to a physician-surgical clinician. Ta.
The high rate of people finding behavioral health services purchased out of network means there is a shortage of behavioral health professionals available in insurance plans' networks, according to the report.
According to the report, behavioral health specialists tend to be less reimbursed for in-network visits than physician assistants, which is a “disincentive for behavioral health providers to join networks. ”.
The report suggests states should “expand behavioral health networks” and offer higher reimbursement rates to behavioral health professionals to encourage participation in behavioral health provider networks. .
On the other hand, the report points out that there is room for improvement in Maryland's “out-of-network usage disparity.” The Maryland Mental Health Association agrees.
According to a Wednesday news release from the mental health advocacy nonprofit, “The data from this study shows that Maryland has , indicating that it is one of the lowest states in the nation.”
Nationally, patients are 8.9 times more likely to see an out-of-network psychiatrist than a medical or surgical specialist. However, Marylanders are 21.1 times more likely to see an out-of-network psychiatrist than a medical or surgical specialist, the fourth-highest rate in the nation after Kentucky, Rhode Island, and Massachusetts. ing.
Even worse for psychologists, Marylanders are 36.4 times more likely to use an out-of-network psychologist than a medical or surgical specialist. This is 10.6 times more likely than the national average to use an out-of-network psychologist, making it the second-worst disparity after Massachusetts.
In response to the report, the Maryland Mental Health Association added that in-network behavioral health specialists are compensated 23% less than other physicians performing similar services in Maryland.
However, the Maryland General Assembly and the Moore administration have worked to improve access to behavioral care across the state.
“In recent years, the Maryland Insurance Administration (MIA) has become one of the most vigorous regulatory agencies in the nation in enforcing state and federal parity laws,” said Linda Raines, chief executive officer of the Maryland Mental Health Association. ” Written Statement. “The MIA has already implemented some of the recommendations in this report, and new legislation passed by the Maryland General Assembly this year will further strengthen the MIA's enforcement powers.”
During the 2024 session, Congress passed measures to improve parity between behavioral health and traditional health care services.
Senate Bill 684, introduced by Sen. Malcolm Augustine (D-Prince George's), would strengthen reporting requirements from insurance companies regarding coverage for behavioral health services and allow the state Insurance Commissioner to enforce reporting requirements by the state Insurance Commissioner if an insurance company does not comply with reporting. Made fines easier to impose. requirements.
The bill would also place a “burden of persuasion” on insurers to prove their compliance with federal parity laws.
SB 684 was unanimously approved by the House and Senate and now awaits consideration by Gov. Wes Moore (D).
A joint House bill, House Bill 1074, was also unanimously approved by both chambers and sent to the Governor's desk. Rep. Heather Bagnall (D-Anne Arundel) is the bill's lead sponsor, with Democrats and Republicans co-sponsoring it.
