Maryland proposes an overhaul of health network adequacy guidelines for health insurance carriers

Maryland is closing the comment period on its proposed changes to the network adequacy chapter of Title 31 Maryland Insurance Administration. The proposal, published in the Maryland Register on Feb. 24, 2023, extensively changes data and documentation procedures for health insurance carriers in the state.

New standards will require carriers to map the “road travel distance” (aka driving distance) from all Maryland enrollees that use the carrier’s network of providers, mapping from everyone’s individual residences to their care provider for certain services. The state guidance includes a chart with various distances broken out by urban, suburban, and rural travel expectations.

For instance, while rheumatology services must be within 15 miles of an urban enrollee, 40 miles of a suburban enrollee, or 90 miles of a rural enrollee, OB/GYN services such as a certified nurse-midwife must be within 5 miles of urban enrollees, 10 miles of suburban enrollees, and 30 miles of rural enrollees.

Part of the updates are routine, acknowledging emergent areas of expertise like “addiction medicine,” which has been added to the maximum distance chart. Other updates include culturally significant trends. For instance, the proposal will require carriers to track the accommodations they make for different populations, like how many providers have environments that accommodate patients with physical or mental disabilities.

Another case in point: Carriers must report how many primary care physicians in their network can speak American Sign Language, Spanish, Korean, Mandarin, Cantonese, Tagalog, and French.

The provision will also require carriers to demonstrate they “take reasonable steps to ensure services are delivered in a culturally competent manner” to communities who have limited English proficiency; varied cultural, racial, or ethnic values; or different genders, sexual orientations, and gender identities, from medical needs to claims processing. New reporting requirements mean carriers must track both their network providers’ specifics as well as their covered enrollees’ needs, and audit their data to show today’s reality and any attempts they’re making at progress in these areas.

Telehealth also makes a sizable appearance in new reporting requirements. Carriers can get credit for covering telehealth visits in order to meet distance guidelines, but those credits are subject to specific limitations and caps.

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