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« April 2014 »
 On October 1, 2013, individuals and families in Maryland will be able to shop for medical insurance coverage through a newly opened marketplace, run by the state and called the Maryland Health Connection (MHC). [The small employer marketplace will open January 1—see p.

MedChi and the Maryland Rx Card Program are making available to every Marylander access to the lowest price on prescriptions.  No enrollment forms, restrictions, waiting periods, or age/income requirements.   This program is accepted at more than 54,000 pharmacies across the country. Go to and select “The Maryland Rx Card” to download a FREE prescription drug card.    

Integration of “behavioral health services” with “somatic care” has been a hot subject for several months, for state government, the MPS and other stakeholders. Since my last column in July, our MPS Behavioral Health Integration Workgroup (BHI Workgroup) has continued to work diligently, studying relevant literature and reports, participating in state workgroup meetings, making our presence known, and contributing actively and significantly to the deliberations with the DHMH and other stakeholders.

Maryland has been working for several months on integration of “behavioral health services” with “somatic care.”  The MPS Behavioral Health Integration Workgroup (BHI Workgroup) has contributed actively to the deliberations with the DHMH and other stakeholders.

An estimated 20 percent gap between what Medicare pays physicians and their cost to provide the care means that some physicians have had to limit the number of Medicare patients they see or withdraw from Medicare altogether. The Medicare

The Maryland Parity Project reports that beginning this year any insurer who wishes to have their utilization review policies, procedures, and criteria accredited by the Utilization Review Accrediting Commission (URAC) will need to demonstrate compliance with the Mental Health Parity and Addiction Equity Act.  Consumers insured by URAC-accreditated plans can file complaints about non-compliance with URAC at  MPS member, Steven R.

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA, the Parity Act) ushered in a new era for health insurance coverage for mental health and substance use (mh/sud) disorders. The foundation for this was laid by the Mental Health Parity Act of 1996, and, significantly, the Patient Protection and Affordable Care Act (the ACA) that was passed in 2010 contains a number of provisions that expand the reach of the mental health parity requirements of MHPAEA through yet-to-be-established health plans .

Every Maryland resident is eligible to participate in the Maryland Rx Card program, which has no membership restrictions and no applications to fill out. It can be used by individuals with high deductible plans, or who do not qualify for public funded programs such as Medicaid and Medicare, or who receive medicines through charity care providers and require a drug that is not available to them. The card is accepted at over 56,000 regional and national pharmacies.

Senate Bill 314 Health Insurance - Assignment of Benefits and Reimbursement of Non-preferred Providers, applies to PPO insurance policies issued, delivered or renewed on or after July 1, 2011.  The bill requires an insurer to recognize an assignment of benefits (AOB) and to send the insurance payment directly to the physician who accepts AOB.  The bill creates an important tool for physicians in private practice.  MedChi has posted information to its website to help physicians understand the new law. Go to

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