Uniform Treatment Plan Form Regulations

BULLETIN To: Private Review Agents Health Maintenance Organizations Non-profit Health Service Plans Health Insurers Re: Uniform Treatment Plan Form Regulations Date: September 20, 2000 Bulletin: Life and Health 00-19 Chapters 111 and 112 of the Acts of the General Assembly of 1998 transferred to the Maryland Insurance Administration the responsibility to regulate private review agents. The legislation also required the Insurance Commissioner, after consultation with payors and licensed or certified providers of treatment for a mental illness, emotional disorder, or substance abuse disorder to adopt regulations to implement the uniform treatment plan form. Purpose and Applicability Under the authority of Title 15, Subtitle 10B “Private Review Agents” of the Insurance Article and COMAR 31.10.21, the uniform treatment plan form was developed for private review agents who require health care providers to submit a treatment plan to enable the private review agent to conduct utilization review of services for the treatment of a mental illness, emotional disorder, or a drug or alcohol abuse disorder. The uniform treatment plan form does not apply to a person or entity that uses a treatment plan form soley for internal purposes. Acceptance of the Form by the Private Review Agent All private review agents who are doing business in Maryland, must accept the uniform treatment plan form as a properly submitted treatment plan form and may not require a health care provider to: 1) Modify the uniform treatment plan form or its content, except: (a) to provide stamps or preprinted stickers to include additional information to the carrier information block on the uniform treatment plan form; or (b) the private review agent may pre-print the designated carrier information in the carrier information block on the uniform treatment plan form; or 2) Submit additional treatment plan forms. General Instructions for Use of the Uniform Treatment Plan Form The health care provider must use and properly complete the uniform treatment plan form. A private review agent may provide a set of instructions for use by the health care provider regarding the private review agent’s specific managed care requirements. The uniform treatment plan form may be submitted by electronic transfer. Effective Date The regulations governing the uniform treatment plan form are effective August 21, 2000. The regulations are applicable for treatment plan forms used on or after October 1, 2000. Responsibility of the Private Review Agent Access to the Uniform Treatment Plan Form The private review agent is responsible for providing the uniform treatment plan form to the health care provider when the health provider makes a request for health care services. The uniform treatment plan form is attached to this bulletin. It is also available on the MIA website at www.mdinsurance.state.md.us. Section 15-10B-17 of the Insurance Article governs enforcement by the MIA of activities of private review agents. Questions about this bulletin may be directed to Felicia Johnson at (410) 468-2259 or (800) 492-6116 extension 2259. ____________________________________ Wendy Taparanskas, PhD. Associate Commissioner Life and Health