Maryland Regulations
Insurance Administration
Vol. 47, Issue 7, Maryland Register 2020-03-27 pp.382-383
PUBLICATION DATE: 03/27/2020
ACTION DATE: 03/27/2020
EFFECTIVE DATE: 03/09/2020
EXPIRATION DATE: 09/05/2020
PUBLICATION TYPE: Register

Title 31

MARYLAND INSURANCE ADMINISTRATION

Subtitle 01 GENERAL PROVISIONS

31.01.02 Emergency Powers

Authority: Health-General Article, §19-706; Insurance Article, §2-115; Annotated Code of Maryland

Notice of Emergency Action

[20-075-E]

The Joint Committee on Administrative, Executive, and Legislative Review has granted emergency status to amendments to Regulations .03 and .06 under COMAR 31.01.02 Emergency Powers.

Emergency status began: March 9, 2020.

Emergency status expires: September 5, 2020.

Comparison to Federal Standards

There is no corresponding federal standard to this emergency action.

Estimate of Economic Impact

I. Summary of Economic Impact. The requirements in the proposed regulation for insurance carriers to waive cost-sharing and pay claims for specified medical services associated with COVID-19 will have a positive fiscal impact on consumers and a negative fiscal impact on insurance carriers. Consumers covered under health plans subject to regulation by the Commissioner will save money by having their share of costs waived for certain preventive, testing, diagnostic, and lab services for COVID-19 and potentially having their insurance coverage pay for new treatments for COVID-19 that would otherwise be denied as experimental. This will remove potential barriers for consumer to access these services. Conversely, insurance carriers will experience increased costs because they will not be permitted to deduct cost-sharing from their payment for these services, and may be required to pay certain claims for COVID-19 treatment that would otherwise be denied as experimental. The magnitude for these fiscal impacts is impossible to quantify at this time due to the variance in cost-sharing levels for the affected services under different plans, the variance in provider charges for these services, and the uncertainty about the number of consumers who will need to access these services. Employees of small businesses that have purchased insurance plans subject to regulation by the Commissioner will be eligible for the cost-sharing waivers, but, otherwise, these proposed regulations will have no direct impact on small businesses.

Revenue (R+/R-)
II. Types of Economic Impact. Expenditure (E+/E-) Magnitude
A. On issuing agency: NONE
B. On other State agencies: NONE
C. On local governments: NONE
Benefit (+) Cost (-) Magnitude
D. On regulated industries or trade groups: NONE
Cost (-) Unknown
E. On other industries or trade groups: NONE
F. Direct and indirect effects on public: NONE
Cost reduction (+) Unknown

III. Assumptions. (Identified by Impact Letter and Number from Section II.)

D. Insurance carriers will experience increased costs because they will not be permitted to deduct cost-sharing from their payments for these services, and may be required to pay certain claims for COVID-19 treatment that would otherwise be denied as experimental. The magnitude for these fiscal impacts is unknown due to the variance in cost-sharing levels for the affected services under different plans, the variance in provider charges for these services, and the uncertainty about the number of consumers who will need access to these services.

F. Consumers covered under health plans subject to regulation by the Maryland Insurance Administration will save money by having their share of costs waived for certain preventive, testing, diagnostic, and lab services for COVID-19 and potentially having their insurance coverage pay for new treatments for COVID-19 that would otherwise be denied as experimental.

Economic Impact on Small Businesses

The emergency action has minimal or no economic impact on small businesses.

ALFRED W. REDMER, JR.

Insurance Commissioner

.03 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(10) (text unchanged)

(11) "Copayment" means a specified charge that a covered person shall pay each time services of a particular type or in a designated setting are received.

(12) "COVID-19" means, interchangeably and collectively, the coronavirus known as COVID-19 or 2019-nCoV and the SARS-CoV-2 virus.

(13) "Deductible" means the amount of allowable charges that shall be incurred by an individual or family per year before a carrier begins payment.

(11)(14)—(23)(26) (text unchanged)

.06 Life and Health.

A. The bulletin issued by the Commissioner under Regulation .05 of this chapter may require health carriers to:

(1)—(2) (text unchanged)

(3) Waive any time restrictions on prescription medication refills and authorize payment to pharmacies for at least a 30-day supply of any prescription medication, regardless of the date upon which the prescription medication had most recently been filled by a pharmacist; and

(4) Waive any restrictions on the time frame for the replacement of durable medical equipment or supplies, eyeglasses, and dentures.;

(5) Except as provided in §§J and K of this regulation, waive any cost-sharing, including copayments, coinsurance, and deductibles, for any visit to diagnose or test for COVID-19, regardless of the setting of the testing (for example, an emergency room, urgent care center, or primary physician's office);

(6) Except as provided in §§J and K of this regulation, waive any cost-sharing, including copayments, coinsurance, and deductibles, for laboratory fees to diagnose or test for COVID-19; and

(7) Except as provided in §§J and K of this regulation, waive any cost-sharing, including copayments, coinsurance, and deductibles, for vaccination for COVID-19.

B.—E. (text unchanged)

F. The Commissioner may require a health carrier to make a claims payment for treatment for COVID-19 that the health carrier has denied as experimental.

G. A health carrier shall evaluate a request to use an out-of-network provider to perform diagnostic testing of COVID-19 solely on the basis of whether the use of the out-of-network provider is medically necessary or appropriate.

H. The only prior authorization requirements a health carrier may utilize relating to testing for COVID-19 shall relate to the medical necessity of that testing.

I. An adverse decision on a request for coverage of diagnostic services for COVID-19 shall be considered an emergency case for which an expedited grievance procedure is required under Insurance Article, §15-10A-02, Annotated Code of Maryland.

J. The requirements of §A(5)—(7) of this regulation do not apply to a Medicare supplement policy as defined by Insurance Article, §15-901(k), Annotated Code of Maryland.

K. A carrier is not required to waive the deductible for an insured covered under a high deductible health plan, as defined in 26 U.S.C. §223, if the waiver of the deductible would disqualify the plan from being considered a high deductible health plan under federal law.