TESTIMONY ON SB 834
Maryland Health Benefit Exchange – Qualified Health Plans – Standards
Senate Finance Committee
March 25 2015
POSITION: SUPPORT
CBH is the professional association for Maryland’s network of community-based programs
serving children and adults who use the public mental health system. Our member agencies
operate outpatient clinics, rehabilitation programs, and a variety of housing, vocational, crisis,
and related support services that help people stay out of hospitals and participate in community
life as productively as possible.
We support this bill first and foremost because it requires the Exchange and the insurance
commissioner to establish standards for network adequacy as applied to qualified health plans
(QHPs). The lack of adequate behavioral health networks in the commercial market has long
been of concern to CBH. It is of even greater concern in the QHPs given the churning between
Medicaid and the Exchange for individuals who go on and off of Medicaid. Many behavioral
health providers who participate in Medicaid do not participate in the Exchange due to the low
reimbursement rates of the latter. This can limit both access and continuity of care for individuals
who move from Medicaid onto the Exchange.
The other reason to support SB 834 is the provisions dealing with QHP formularies. Medications
are extremely important to individuals diagnosed with mental illness, and can mean the
difference between recovery and relapse. It can sometimes take months or even years to find the
right mix of medications that combat the symptoms of the illness without causing serious side
effects. QHPs may be specifically chosen based on access to a needed medication. This bill
would require the QHPs to submit information to the Exchange regarding their formularies, the
tier placement of drugs, and any cost-sharing requirements. It would also prohibit mid-year
changes to the formularies, tier placement of drugs, and cost-sharing requirements that could
adversely impact the ability of individuals with mental illness to remain on a successful drug
regimen.
For these reasons CBH supports SB 834 and urges a favorable report.