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ROBERT L. EHRLICH, JR., Governor S.B. 686
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Senate Bill No. 686
AN ACT concerning
Health Insurance - Carrier Provider Panels - Participation by Providers
FOR the purpose of requiring a health insurance carrier that uses a provider panel to
maintain standards in accordance with certain regulations if the carrier is an
insurer, nonprofit health service plan, or dental plan organization; requiring a
health insurance carrier that uses a provider panel to adhere to certain
standards for accessibility of covered services if the carrier is a health
maintenance organization; requiring a health insurance carrier that uses a
provider panel to establish procedures to verify with each provider on the
carrier's provider panel, at a certain time certain times, whether the provider is
accepting new patients and to promptly update certain information on
participating providers; requiring the carrier to establish procedures to ensure
that there is a sufficient number of certain providers on the carrier's provider
panel to guarantee certain access by an enrollee to covered services; providing
that it is an unfair trade practice under certain provisions of law for a carrrier to
fail to accurately maintain and provide certain information to enrollees or to fail
to maintain a certain number of providers on the carrier's provider panel;
providing that certain provisions of this Act may not be construed to require a
carrier to allow a provider to take a certain action; requiring a carrier to update
certain provider information within a certain time period: altering the procedure
for referral to a specialist who is not part of a carrier's provider panel; requiring
a carrier to treat a certain service in a certain manner, for certain purposes;
altering a certain definition requiring the Maryland Insurance Administration,
in consultation with certain parties, to adopt certain regulations on or before a
certain date, and to take into consideration certain standards and procedures in
. adopting the regulations; requiring certain insurers, nonprofit health service
plans, and dental plan organizations to comply with the regulations on or before
a certain date; requiring the Administration, on or before a certain date, to
conduct a certain study and report op the findings and recommendations of its
study to certain legislative committees; and generally relating to health
insurance carrier provider panels.
BY repealing and reenacting, with amendments,
Article - Insurance
Section 15-112(b) and (j) and 15-830
Annotated Code of Maryland
(2002 Replacement Volume and 2005 Supplement)
BY adding to
Article - Insurance
Section 15-112(m)
Annotated Code of Maryland
(2002 Replacement Volume and 2005 Supplement)
- 3197 -
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