PARRIS N. GLENDENING, Governor                             Ch. 604

(2) ALL MEMBERSHIP ENROLLMENT MATERIALS SHALL CLEARLY
INDICATE THE OFFICE, INCLUDING THE TELEPHONE NUMBER AND THE PROCESS
FOR FILING A COMPLAINT, WITHIN THE DEPARTMENT OF HEALTH AND MENTAL
HYGIENE OR THE ADMINISTRATION THAT IS RESPONSIBLE FOR RECEIVING AND
RESPONDING TO ENROLLEE'S COMPLAINTS CONCERNING CARRIERS.

(H) (1) A CARRIER THAT TERMINATES A PARTICIPATING PROVIDER FOR
REASONS OTHER THAN PROFESSIONAL COMPETENCE SHALL CONTINUE TO
REIMBURSE THE PROVIDER FOR A PERIOD OF AT LEAST 60 DAYS FOR THE
PROVIDER'S SERVICES TO THE CARRIER'S ENROLLEES WHO ELECT TO CONTINUE
WITH THE PROVIDER.

(2) REIMBURSEMENT UNDER THIS SUBSECTION SHALL BE THE LESSER
OF:

(I) THE RATE USED BY THE CARRIER TO REIMBURSE
NONPARTICIPATING PROVIDERS; OR

(II) THE USUAL AND CUSTOMARY RATE OF THE PROVIDER.

657.

(a) If a preferred provider insurance policy offered by an insurer provides benefits
for any service that is within the lawful scope of practice of a health care provider licensed
under the Health Occupations Article, any insured covered by the preferred provider
insurance policy shall be entitled to receive the benefits for that service either through
direct payments to the provider or to reimbursement to the insured.

(b) (1) A preferred provider insurance policy offered by an insurer under this
subtitle shall provide for payment of services rendered by nonpreferred providers as
provided under this section.

(2) UNLESS THE INSURER DEMONSTRATES TO THE SATISFACTION OF
THE COMMISSIONER THAT AN ALTERNATIVE LEVEL OF PAYMENT IS MORE
APPROPRIATE UNDER THE CIRCUMSTANCES, AN INSURER SHALL REIMBURSE A
PHARMACY PROVIDER, AFTER ALL DEDUCTIBLE AND COPAYMENT PROVISIONS
HAVE BEEN APPLIED, IN THE FOLLOWING MANNER;

(I) EITHER THE RATE OF REIMBURSEMENT TO A PREFERRED
PROVIDER FOR THE COST OF THE DRUG PRODUCT OR THE CURRENT MARYLAND
MEDICAL ASSISTANCE PROGRAM'S FORMULA FOR THE CALCULATION OF THE COST
OF THE DRUG PRODUCT; AND

(II) A DISPENSING FEE IN ACCORDANCE WITH PARAGRAPH (3) OF
THIS SUBSECTION.

[(2)](3) [Unless] EXCEPT AS PROVIDED IN PARAGRAPH (4) OF THIS
SUBSECTION, UNLESS the insurer demonstrates to the satisfaction of the Insurance
Commissioner that an alternative level of payment is more appropriate under the
circumstances, aggregate payments in any full calendar year made under this paragraph to
nonpreferred providers after all deductible and copayment provisions have been applied

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