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2006 LAWS OF MARYLAND
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Ch. 554
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(21 "AMBULATORY SURGICAL FACILITY" HAS THE MEANING STATED IN §
19-3B-01 OF THE HEALTH - GENERAL ARTICLE.
(2) (3) (i) "Carrier" means:
1. an insurer;
2. a nonprofit health service plan;
3. a health maintenance organization;
4. a dental plan organization; or
5. any other person that provides health benefit plans
subject to regulation by the State.
(ii) "Carrier" includes an entity that arranges a provider panel for a
carrier.
(3) (4) "Enrollee" means a person entitled to health care benefits from
a carrier.
(5) "HOSPITAL" HAS THE MEANING STATED IN § 19-301 OF THE HEALTH -
GENERAL ARTICLE.
(4) (6) "Provider" means a health care practitioner or group of health
care practitioners licensed, certified, or otherwise authorized by law to provide health
care services.
(5) (7) (i) "Provider panel" means the providers that contract either
directly or through a subcontracting entity with a carrier to provide health care
services to the carrier's enrollees under the carrier's health benefit plan.
(ii) "Provider panel" does not include an arrangement in which any
provider may participate solely by contracting with the carrier to provide health care
services at a discounted fee-for-service rate.
(M) A CARRIER MAY NOT INCLUDE IN A CONTRACT WITH A PROVIDER,
AMBULATORY SURGICAL FACILITY. OR HOSPITAL A TERM OR CONDITION THAT:
(1) PROHIBITS THE PROVIDER. AMBULATORY SURGICAL FACILITY, OR
HOSPITAL FROM OFFERING TO PROVIDE SERVICES TO THE ENROLLEES OF ANOTHER
CARRIER AT A LOWER RATE OF REIMBURSEMENT;
(2) REQUIRES THE PROVIDER, AMBULATORY SURGICAL FACILITY, OR
HOSPITAL TO PROVIDE THE CARRIER WITH THE SAME REIMBURSEMENT
ARRANGEMENT THAT THE PROVIDER, AMBULATORY SURGICAL FACILITY, OR
HOSPITAL HAS WITH ANOTHER CARRIER IF THE REIMBURSEMENT ARRANGEMENT
WITH THE OTHER CARRIER IS FOR A LOWER RATE OF REIMBURSEMENT; OR
(3) REQUIRES THE PROVIDER, AMBULATORY SURGICAL FACILITY, OR
HOSPITAL TO CERTIFY TO THE CARRIER THAT THE REIMBURSEMENT RATE BEING
PAID BY THE CARRIER TO THE PROVIDER, AMBULATORY SURGICAL FACILITY, OR
- 2694 -
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