2013 Maryland Code
INSURANCE
§ 31-116 - Essential health benefits to be benefits in State benchmark plan and other plans under this subtitle.

§31-116.

(a) The essential health benefits required under § 1302(a) of the Affordable Care Act:

(1) shall be the benefits in the State benchmark plan, selected in accordance with this section; and

(2) notwithstanding any other benefits mandated by State law, shall be the benefits required in:

(i) all individual health benefit plans and health benefit plans offered to small employers, except for grandfathered health plans, as defined in the Affordable Care Act, offered outside the Exchange; and

(ii) subject to § 31-115(c) and (d) of this title, all qualified health plans offered in the Exchange.

(b) In selecting the State benchmark plan, the State seeks to:

(1) balance comprehensiveness of benefits with plan affordability to promote optimal access to care for all residents of the State;

(2) accommodate to the extent practicable the diverse health needs across the diverse populations within the State; and

(3) ensure the benefit of input from the stakeholders and the public.

(c) (1) The State benchmark plan shall be selected by the Maryland Health Care Reform Coordinating Council through an open, transparent, and inclusive process.

(2) Any action of the Council may be taken only by the affirmative vote of at least nine members of the Maryland Health Care Reform Coordinating Council.

(3) In selecting the State benchmark plan, the Maryland Health Care Reform Coordinating Council may exclude:

(i) a health care service, benefit, coverage, or reimbursement for covered health care services that is required under this article or the Health - General Article to be provided or offered in a health benefit plan that is issued or delivered in the State by a carrier; or

(ii) reimbursement required by statute, by a health benefit plan for a service when that service is performed by a health care provider who is licensed under the Health Occupations Article and whose scope of practice includes that service.

(d) In selecting the State benchmark plan, the Maryland Health Care Reform Coordinating Council shall:

(1) obtain guidance necessary to:

(i) determine the 10 health benefit plans deemed eligible by the Secretary to be the State benchmark plan; and

(ii) conduct a comparative analysis of the benefits of each plan;

(2) solicit the input of stakeholders in the State, including members of the General Assembly and members of the public, by:

(i) appointing and consulting with an advisory group made up of a diverse and representative cross-section of stakeholders, including:

1. individuals with knowledge of and expertise in advocating for consumers representing lower income, racial, ethnic, or other minorities, individuals with chronic diseases and other disabilities, and vulnerable populations;

2. public health researchers and other academic experts with relevant knowledge and background, including knowledge and background relating to disparities and the health needs of diverse populations; and

3. carriers, health care providers, and other industry representatives with knowledge and expertise relevant to health plan benefits and design;

(ii) to the extent practicable, appointing individuals to the advisory group who reflect the gender, racial, ethnic, and geographic diversity of the State; and

(iii) establishing a mechanism for members of the General Assembly and members of the public to:

1. be kept informed by electronic mail; and

2. provide comment; and

(3) select a plan that complies with all requirements of this title and the Affordable Care Act, the federal Mental Health Parity and Addiction Equity Act of 2008, and any other federal laws, regulations, policies, or guidance applicable to state benchmark plans and essential health benefits.

(e) On or before September 30, 2012, the Maryland Health Care Reform Coordinating Council shall select the State benchmark plan for coverage beginning January 1, 2014.