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ROBERT L. EHRLICH, JR., Governor
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S.B. 686
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(i) the primary care physician of the member determines, in
consultation with the specialist, that the member needs continuing care from the
specialist;
(ii) the member has a condition or disease that:
1. is life threatening, degenerative, chronic, or disabling; and
2. requires specialized medical care; and
(iii) the specialist:
1. has expertise in treating the life-threatening,
degenerative, chronic, or disabling disease or condition; and
2. is part of the carrier's provider panel.
(3) Except as provided in subsection (c) of this section, a standing
referral shall be made in accordance with a written treatment plan for a covered
service developed by:
(i) the primary care physician;
(ii) the specialist; and
(iii) the member.
(4) A treatment plan may:
(i) limit the number of visits to the specialist;
(ii) limit the period of time in which visits to the specialist are
authorized; and
(iii) require the specialist to communicate regularly with the
primary care physician regarding the treatment and health status of the member.
(5) The procedure by which a member may receive a standing referral to
a specialist may not include a requirement that a member see a provider in addition
to the primary care physician before the standing referral is granted.
(c) (1) Notwithstanding any other provision of this section, a member who is
pregnant shall receive a standing referral to an obstetrician in accordance with this
subsection.
(2) After the member who is pregnant receives a standing referral to an
obstetrician, the obstetrician is responsible for the primary management of the
member's pregnancy, including the issuance of referrals in accordance with the
carrier's policies and procedures, through the postpartum period.
(3) A written treatment plan may not be required when a standing
referral is to an obstetrician under this subsection.
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- 3201 -
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