PARRIS N. GLENDENING, Governor                             Ch. 604

Approved May 25, 1995.

CHAPTER 604
(House Bill 724)

AN ACT concerning

Patient Access Act

FOR the purpose of requiring certain carriers that use certain panels of providers to
provide certain services to enrollees to establish certain criteria and procedures for
membership on those panels and maintain the criteria and procedures at a certain
location for a certain purpose and under certain circumstances; requiring a carrier
to provide the criteria and procedures to any provider requesting an application for
membership on a carrier's provider panel; requiring the Insurance Commission and
the Secretary of Health and Mental Hygiene to adopt certain regulations relating to
the criteria and procedures; providing certain review and appeal procedures to
certain persons under certain circumstances; prohibiting a carrier from denying
membership on a panel on the basis of gender, race, age, religion, national origin, or
disability; prohibiting a carrier from restricting or terminating membership on a
provider panel under certain circumstances; authorizing a carrier to restrict
membership on a provider panel under certain circumstances; requiring carriers to
include certain information in the carrier's marketing materials; requiring a carrier
that terminates a participating provider for certain reasons to continue to reimburse
the provider a certain amount for a certain period of time; requiring certain
insurers, including health maintenance organizations, to reimburse certain
providers, including pharmacy providers, in a certain manner under certain
circumstances; providing that certain enrollee and subscriber liability provisions are
not applicable under certain circumstances; providing a certain exception; defining
certain terms; making provisions of this Act severable; requiring a certain carrier,
that uses a provider panel to provide certain health care services to enrollees, to
establish certain procedures for notifying enrollees and certain individuals of
certain information and for formulating the carrier's provider panel in a certain
manner; requiring a carrier to provide an application for participation in its
provider panel, and certain other information, to any provider upon request;
requiring a carrier to take certain action in regard to an application for participation
in the carrier's provider panel within a certain time and under certain
circumstances; authorizing a carrier to charge a certain fee for any application a
provider submits to the carrier; requiring a carrier to provide to new members and
existing enrollees certain information under certain circumstances; prohibiting a carrier
from denying participation or terminating participation in its provider panel on the
basis of gender, race, age, religion, national origin, or disability and under certain
other circumstances; requiring a carrier to establish an internal review system for a
certain purpose; requiring a provider being terminated from a carrier's provider
panel to continue to provide health care services to enrollees for a certain period
after the date of the notice of the provider's termination under certain

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