The Maryland Health Care Commission (MHCC) is planning to submit amendments on certain preauthorization benchmarks for providing health services. The informal draft would amend the Code of Maryland Regulations (COMAR) 10.25.17, and is accepting public comment until 4:30 p.m. Eastern Time on May 13, 2022.
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The preauthorization regulations were first established in 2012. They required state-regulated insurers, nonprofit health services plans, health maintenance organizations, and certain pharmacy benefit managers to begin implementing an electronic preauthorization process, and to adhere to four benchmarks. In 2013, MHCC adopted a process that would allow payors to waive one or more of the benchmarks to gain preauthorization.
The current regulations specify four benchmarks payors must meet regarding the preauthorization of health services. These include establishing online access for providers to request preauthorization, which services need it, and the criteria for requiring preauthorization.
Payors may request a waiver for one or more benchmarks for extenuating circumstances, such as maintaining a premium volume of less than $1 million annually or out-of-network providers.
The proposed changes mainly update outdated language in the regulations, but also establish a waiver withdrawal process. If the Commission’s executive director determines a payor no longer demonstrates circumstances that grant them a waiver, they may withdraw it after notifying the payor.
The change goes on to require the payor to submit to the executive director in no more than 30 days after notification, a plan to meet the previously waived benchmarks.
Another proposed change extends the timeframe for a payor to begin offering health services in Maryland from within 30 days to three months after authorization. Also, the timeline for the establishment or renewal of a preauthrization benchmark waiver is being extended from two years to five.
The Commission is accepting public comment on the proposed changes until 4:30 p.m. Eastern Time on May 13th. They may be sent my mail or email to Justine Springer at [email protected]; or:
Maryland Health Care Commission
ATTN: Justine Springer
4160 Patterson Ave
Baltimore, MD 21215