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Session Laws, 2006
Volume 750, Page 3200   View pdf image
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VETOES
S.B. 686
(I)      3 WORKING DAYS AFTER THE DATE THE PARTICIPATING
PROVIDER PLACED THE NOTIFICATION IN THE U.S. MAIL, IF THE PARTICIPATING
PROVIDER MAINTAINS THE STAMPED CERTIFICATE OF MAILING FOR THE NOTICE;
OR (II)     ON THE DATE RECORDED BY THE COURIER, IF THE
NOTIFICATION WAS DELIVERED BY COURIER (5) IT IS AN UNFAIR TRADE PRACTICE UNDER § 27-102 OF THIS ARTICLE
FOR A CARRIER TO: (I) FAIL TO ACCURATELY MAINTAIN AND PROVIDE TO ENROLLEES
INFORMATION ON WHETHER A PROVIDER IS ACCEPTING NEW PATIENTS; OR (II) FAIL TO MAINTAIN A SUFFICIENT NUMBER OF PROVIDERS ON
THE CARRIER'S PROVIDER PANEL TO MEET THE REQUIREMENTS OF SUBSECTION
(B)(5) OF THIS SECTION. 15-830. (a)     (1) In this section the following words have the meanings indicated. (2)     "Carrier" means: (i) an insurer that offers health insurance other than long-term
care insurance or disability insurance; (ii) a nonprofit health service plan; (iii) a health maintenance organization; (iv) a dental plan organization; or (v) except for a managed care organization as defined in Title 15,
Subtitle 1 of the Health - General Article, any other person that provides health
benefit plans subject to State regulation. (3)     (i) "Member" means an individual entitled to health care benefits
under a policy or plan issued or delivered in the State by a carrier. (ii) "Member" includes a subscriber. (4)     "Provider panel" [means those providers with which a carrier
contracts to provide services to its members] HAS THE MEANING STATED IN §
15-112(A) OF THIS TITLE. (5)     "Specialist" means a physician who is certified or trained to practice
in a specified field of medicine and who is not designated as a primary care provider
by the carrier. (b)     (1) Each carrier that does not allow direct access to specialists shall
establish and implement a procedure by which a member may receive a standing
referral to a specialist in accordance with this subsection. (2) The procedure shall provide for a standing referral to a specialist if: - 3200 -


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Session Laws, 2006
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