WILLIAM DONALD SCHAEFER, Governor                        H.B. 1563

(2) "ENROLLEE" MEANS AN INDIVIDUAL OR MEMBER OF A GROUP TO
WHOM A HEALTH NETWORK IS OBLIGATED TO PROVIDE HEALTH CARE SERVICES.

(3) (I) "HEALTH NETWORK" MEANS A GROUP OF HEALTH CARE
PROVIDERS THAT:

1. IS ORGANIZED TO PROVIDE HEALTH CARE SERVICES TO
AN ENROLLED POPULATION IN A REGIONAL AREA OR SERVICE AREA; AND

2. IS RESPONSIBLE FOR DELIVERING OR ARRANGING FOR
THE DELIVERY OF THE FULL CONTINUUM OF SERVICES INCLUDED IN A
COMPREHENSIVE HEALTH BENEFIT PLAN TO ENROLLEES;

(II) A HEALTH NETWORK MAY BE FORMED AS EITHER:

1.        A PROVIDER HEALTH NETWORK; OR

2.        AN INTEGRATED HEALTH NETWORK.

(4) "HEALTH PROVIDER" MEANS:

(I) A PERSON WHO IS LICENSED, CERTIFIED, OR OTHERWISE
AUTHORIZED UNDER THE HEALTH OCCUPATIONS ARTICLE TO PROVIDE HEALTH
CARE IN THE ORDINARY COURSE OF BUSINESS OR PRACTICE OF A PROFESSION OR
IN AN APPROVED EDUCATION OR TRAINING PROGRAM; OR

(II) A FACILITY WHERE HEALTH CARE IS PROVIDED TO PATIENTS
OR RECIPIENTS, INCLUDING A FACILITY AS DEFINED IN § 10-101(E) OF THE HEALTH -
GENERAL ARTICLE, A HOSPITAL AS DEFINED IN § 19-301(F) OF THE HEALTH -
GENERAL ARTICLE, A RELATED INSTITUTION AS DEFINED IN § 19-301(L) OF THE
HEALTH - GENERAL ARTICLE, AN OUTPATIENT CLINIC, AND A MEDICAL
LABORATORY.

(5) "INTEGRATED HEALTH NETWORK" MEANS A NETWORK JOINTLY
OWNED OR CONTROLLED BY HEALTH CARE PROVIDERS OR PAYORS THAT
CONTRACTS DIRECTLY WITH INDIVIDUALS, EMPLOYERS, OR ORGANIZATIONS TO
PROVIDE A HEALTH BENEFIT PLAN AND RETAINS THE RISK FOR DELIVERING OR
ARRANGING FOR THE DELIVERY OF THE FULL CONTINUUM OF SERVICES INCLUDED
IN A COMPREHENSIVE HEALTH BENEFIT PLAN.

(6) "PAYOR" MEANS A:

(I) HEALTH INSURER OR NONPROFIT HEALTH SERVICE PLAN
THAT HOLDS A CERTIFICATE OF AUTHORITY AND PROVIDES HEALTH INSURANCE
POLICIES OR CONTRACTS IN THE STATE IN ACCORDANCE WITH THIS ARTICLE OR
THE HEALTH - GENERAL ARTICLE;

(II)     HEALTH MAINTENANCE ORGANIZATION THAT IS LICENSED IN
THE STATE; OR

(III)   THIRD PARTY ADMINISTRATOR OR ANY ENTITY UNDER
CONTRACT WITH A MARYLAND BUSINESS TO ADMINISTER HEALTH CARE BENEFITS.

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