American Society of Plastic Surgeons
For Consumers

STATE | ASPS engages Maryland on new network adequacy proposal

In August, ASPS submitted comments to the Maryland Insurance Administration (MIA) regarding the state's newly proposed network adequacy regulations. These regulations were mandated through legislation that was signed into law by Governor Hogan in April 2016. The legislation also required the Maryland Insurance Commissioner to conduct monthly stakeholder meetings on relevant issues, including geographic access to specialty providers and waiting times for appointments with specialists.

Following a year of stakeholder meetings, the Administration drafted a proposal that establishes travel distance standards for specialty care, as well as wait times for both urgent and non-urgent services. ASPS thanked the MIA for including these very important standards within the regulation.

However, the proposal only set provider to enrollee ratios for primary care and mental health providers. ASPS strongly believes that ratios are necessary for all providers, as wait time and travel distance standards can only be effective if carriers participate with enough physicians. In the Society's August 21 letter to the MIA, ASPS stressed the need to establish minimum ratios for all providers, not just those in primary care and mental health.

The Society's letter also encouraged the Administration to adopt more explicit regulations on carrier waiver request standards. Insurance carriers have consistently demonstrated an unwillingness to negotiate a fair rate with physicians, which often leads physicians to refuse the proposed contract. If the MIA's regulation is adopted as written, carriers will be able to reference that refusal in their request to receive a one-year waiver. ASPS urged the Administration to adopt standards that hold insurance carriers accountable and encourage good faith negotiations with providers.