Front and center for the chapter has been growing concern over the administrative burdens that have been utilized by insurance carriers.  These burdens take many forms including the application of high copays for patients, which serve as a disincentive for patients to utilize PT services to their fullest.  Further complicating the healthcare delivery landscape, insurers often require prior authorization before they approve coverage for treatment and PT services. 

Fair CoPays:

APTA MD introduced legislation during the 2022 Legislative Session that would have limited the cost of copays to a rate similar to primary care copays.  The insurance carriers came out in strong opposition to the bill as introduced.  Our legislative sponsors in the House and Senate worked hard to prevent the defeat of the bills outright and were successful in moving the issue for a summer study by the Maryland Health Care Commission (MHCC). 

The study was conducted with some input by APTA MD, but there was more of an emphasis on the cost implications of a revised copay structure for PT services.  The study was positive in that it acknowledged the important services PT provides and the benefit of those services to improving patient’s health care overall.  The study also showed the potential for increased access to care, while noting the potential for an uptick in utilization.  The study fell short of recommending adoption of a primary level copay and noted the lack of existing data from other states.

APTA MD is working with APTA National and reaching out to other state component chapters to gather as much data as possible to validate the proposed approach will not negatively disrupt insurance markets or drive-up costs. With additional information that can be gathered we hope to reintroduce legislation in future Sessions.

Prior Authorization:

APTA MD focused a lot of energy on legislation introduced and supported by a Coalition of over 52 medical provider groups and associations from physicians to nurses to mental health providers.  Maryland has current law that attempts to make insurers prior authorization policies transparent and functional.  The challenge increasingly encountered by PT groups and your patients is complicated and often redundant requirements to gain approval for necessary treatment and services.  The legislation (House Bill 305/Senate Bill 308 – listed below) would have improved the prior authorization process by adding transparency, aligning standards, and increasing accountability of the insurers.  APTA MD leadership and members provided testimony in writing, in person and via zoom at the bill hearings, making a compelling case for reform.  The opposition from the insurance companies was intense, and efforts to reach areas of compromise during the session did not succeed. 

The Senate Finance Committee Chairwoman and the House Heath and Government Operations Chairwoman issued a letter directing the healthcare provider Stakeholders to convene meetings over the Summer and Fall with the insurance carriers to examine the issues raised and identify possible solutions.  We as your lobbyists, along with APTA MD leadership will be a leading voice in the discussions.  While the bills did not pass during the 2023 Session, the work over these next few months before the 2024 Session will be important.

Monitored this legislation which seeks to identify and more easily enroll eligible children in Medicaid.

APTA MD was directly engaged in the following legislation.