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S.B. 686 VETOES
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SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:
Article - Insurance
15-112.
(b) (1) (I) A carrier that uses a provider panel shall:
1. IF THE CARRIER IS AN INSURER, NONPROFIT HEALTH
SERVICE PLAN, OR DENTAL PLAN ORGANIZATION, MAINTAIN STANDARDS IN
ACCORDANCE WITH REGULATIONS ADOPTED BY THE COMMISSIONER FOR
AVAILABILITY OF HEALTH CARE PROVIDERS TO MEET THE HEALTH CARE NEEDS OF
ENROLLEES; AND
2. IF THE CARRIER IS A HEALTH MAINTENANCE
ORGANIZATION, ADHERE TO THE STANDARDS FOR ACCESSIBILITY OF COVERED
SERVICES IN ACCORDANCE WITH REGULATIONS ADOPTED UNDER § 19-705.1(B)(1)(II)
OF THE HEALTH - GENERAL ARTICLE; AND
(II) establish procedures to:
(1) 1. review applications for participation on the carrier's provider
panel in accordance with this section;
(2) 2. notify an enrollee of:
(i) A. the termination from the carrier's provider panel of the
primary care provider that was furnishing health care services to the enrollee; and
(ii) B. the right of the enrollee, on request, to continue to receive
health care services from the enrollee's primary care provider for up to 90 days after
the date of the notice of termination of the enrollee's primary care provider from the
carrier's provider panel, if the termination was for reasons unrelated to fraud, patient
abuse, incompetency, or loss of licensure status;
(3) 3. notify primary care providers on the carrier's provider panel of
the termination of a specialty referral services provider; [and]
(4) 4. VERIFY WITH EACH PROVIDER ON THE CARRIERS PROVIDER
PANEL, AT LEAST ANNUALLY THE TIME OF CREDENTIALING AND
RECREDENTIALING, WHETHER THE PROVIDER IS ACCEPTING NEW PATIENTS AND
PROMPTLY UPDATE THE INFORMATION ON PARTICIPATING PROVIDERS THAT THE
CARRIER IS REQUIRED TO PROVIDE UNDER SUBSECTION (J) OF THIS SECTION; AND
(5) ENSURE THAT THERE IS A SUFFICIENT NUMBER OF PROVIDERS IN
EACH SPECIALTY, BOTH ADULT AND PEDIATRIC, ON THE CARRIER'S PROVIDER PANEL
TO GUARANTEE THAT AN ENROLLEE CAN ACCESS COVERED SERVICES;
(I) IN AN URBAN AREA, WITHIN 10 MILES OR 30 MINUTES FROM
THE ENROLLEE'S RESIDENCE; OR
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- 3198 -
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