PARRIS N. GLENDENING, Governor                                 Ch. 604

(3) A VIOLATION OF THIS SUBSECTION DOES NOT CREATE A NEW CAUSE OF
ACTION.

(F) (G) EACH CARRIER SHALL ESTABLISH AN INTERNAL REVIEW SYSTEM
TO RESOLVE ANY GRIEVANCES INITIATED BY PROVIDERS THAT ARE
PARTICIPATING IN THE CARRIER'S PROVIDER PANEL, INCLUDING GRIEVANCES
INVOLVING THE TERMINATION OF A PROVIDER FROM PARTICIPATION IN THE
CARRIER'S PROVIDER PANEL.

(G) (H) A CARRIER MAY NOT TERMINATE A PROVIDER FROM
PARTICIPATION IN THE CARRIER'S PROVIDER PANEL, OR OTHERWISE PENALIZE A
PROVIDER, FOR:

(1) ADVOCATING THE INTEREST OF A PATIENT THROUGH THE
CARRIER'S INTERNAL REVIEW SYSTEM; OR BY

(2) FILING AN APPEAL UNDER THE PROVISIONS OF TITLE 19, SUBTITLE
13 OF THE HEALTH - GENERAL ARTICLE; OR

(2) A DISCIPLINARY ACTION BY THE APPROPRIATE LICENSING BOARD
OF THE PROVIDER THAT RESULTS SOLELY BECAUSE OF THE PROVIDERS
ADMINISTRATIVE FAILURE AND NOT FROM A DETERMINATION OF THE BOARD
THAT THE PROVIDER DOES NOT MEET THE STANDARD OF CARE.

(H) (I) (1) FOR A PERIOD OF AT LEAST 90 DAYS FROM THE DATE OF THE
NOTICE OF A PROVIDER'S TERMINATION FROM THE CARRIER'S PROVIDER PANEL
FOR REASONS UNRELATED TO THE TERMS OF THE PROVIDER'S CONTRACT WITH
THE CARRIER- FRAUD, PATIENT ABUSE, INCOMPETENCY, OR LOSS OF LICENSURE
STATUS BY THE PROVIDER, THE PROVIDER SHALL RENDER HEALTH CARE SERVICES
TO ANY OF THE CARRIER'S ENROLLEES WHO:

(I)      WERE RECEIVING HEALTH CARE SERVICES FROM THE
PROVIDER PRIOR TO THE NOTICE OF TERMINATION; AND

(II)     REQUEST, AFTER RECEIVING NOTICE OF THE PROVIDER'S
TERMINATION UNDER SUBSECTION (B) OF THIS SECTION, TO CONTINUE RECEIVING
HEALTH CARE SERVICES FROM THE PROVIDER.

(2) A CARRIER SHALL REIMBURSE A PROVIDER UNDER THIS
SUBSECTION IN ACCORDANCE WITH THE PROVIDER'S AGREEMENT WITH THE
CARRIER.

(I) (1) A NEW ENROLLEE MAY REMAIN WITH A PROVIDER WHO IS NOT A
MEMBER OF THE CARRIER'S PROVIDER PANEL AND IS CURRENTLY PROVIDING
HEALTH CARE SERVICES TO THE ENROLLEE FOR A PERIOD OF UP TO 90 DAYS FROM
THE DATE THE INDIVIDUAL BECAME AN ENROLLEE WITH THE CARRIER IF:

(I) THE ENROLLEE RECEIVES HEALTH CARE SERVICES BENEFITS
THROUGH AN EMPLOYER, ASSOCIATION, OR OTHER GROUP ARRANGEMENT;

(II) THE ENROLLEE'S EMPLOYER, ASSOCIATION, OR OTHER GROUP
ARRANGEMENT DOES NOT OFFER A CONTRACT WITH A CARRIER THAT:

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