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ROBERT L. EHRLICH, JR., Governor S.B. 686
(II) IN A RURAL AREA, WITHIN 30 MILES OR 30 MINUTES FROM THE
ENROLLEE'S RESIDENCE; AND
[(4)] (6) 5. notify a provider at least 90 days before the date of the
termination of the provider from the carrier's provider panel, if the termination is for
reasons unrelated to fraud, patient abuse, incompetency, or loss of licensure status.
(2) THE PROVISIONS OF PARAGRAPH (1)(II)4 OF THIS SUBSECTION MAY
NOT BE CONSTRUED TO REQUIRE A CARRIER TO ALLOW A PROVIDER TO REFUSE TO
ACCEPT NEW PATIENTS COVERED BY THE CARRIER.
(j) (1) A carrier shall make available to prospective enrollees on the
Internet and, on request of a prospective enrollee, in printed form:
(i) a list of providers on the carrier's provider panel; and
(ii) information on providers that are no longer accepting new
patients.
(2) A carrier shall notify each enrollee at the time of initial enrollment
and renewal about how to obtain the following information on the Internet and in
printed form:
(i) a list of providers on the carrier's provider panel; and
(ii) information on providers that are no longer accepting new
patients.
(3) (i) Information provided in printed form under paragraphs (1) and
(2) of this subsection shall be updated at least once a year.
(ii) Information SUBJECT TO SUBSECTION (M) OF THIS SECTION,
INFORMATION provided on the Internet under paragraphs (1) and (2) of this
subsection shall be updated at least once every 15 days.
(4) A policy, certificate, or other evidence of coverage shall:
(i) indicate clearly the office in the Administration that is
responsible for receiving and responding to complaints from enrollees about carriers;
and
(ii) include the telephone number of the office and the procedure for
filing a complaint.
(M) (1) A CARRIER SHALL UPDATE ITS PROVIDER INFORMATION UNDER
SUBSECTION (J)(3)(II) OF THIS SECTION WITHIN 15 WORKING DAYS AFTER RECEIPT
OF WRITTEN NOTIFICATION FROM THE PARTICIPATING PROVIDER OF A CHANGE IN
THE APPLICABLE INFORMATION.
(2) NOTIFICATION IS PRESUMED TO HAVE BEEN RECEIVED BY A
CARRIER:
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- 3199 -
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