Ch. 604                                        1995 LAWS OF MARYLAND

1. INCLUDES THE PROVIDER IN THE CARRIER'S PROVIDER
PANEL; OR

2. ALLOWS AN ENROLLEE TO RECEIVE HEALTH CARE
SERVICES OUTSIDE THE CARRIER'S PROVIDER PANEL.

(2) A CARRIER SHALL REIMBURSE A PROVIDER UNDER THIS
SUBSECTION IN ACCORDANCE WITH THE TERMS AND CONDITIONS THE CARRIER
HAS EXECUTED WITH PROVIDERS IN ITS PROVIDER PANEL FOR SIMILAR SERVICES
IN THE SAME GEOGRAPHIC AREA:

(J) (1) THE MARKETING MATERIALS OF A CARRIER SHALL:

(I) LIST MEMBERS IN ITS PROVIDER PANEL;

(II) INDICATE PROVIDERS WHO ARE NO LONGER ACCEPTING NEW
PATIENTS; AND

(III) BE UPDATED AT LEAST ONCE A YEAR.

(J) (1) A CARRIER SHALL PROVIDE TO A NEW MEMBER PRIOR TO
ENROLLMENT AND TO EXISTING ENROLLEES AT LEAST ONCE A YEAR:

(I) A LIST OF MEMBERS IN ITS PROVIDER PANEL; AND

(II) INFORMATION ON PROVIDERS WHO ARE NO LONGER
ACCEPTING NEW PATIENTS.

(2) THE INFORMATION PROVIDED UNDER PARAGRAPH (1) OF THIS
SUBSECTION SHALL BE UPDATED AT LEAST ONCE A YEAR.

(2) ALL MEMBERSHIP ENROLLMENT MATERIALS

(3) THE EVIDENCE OF COVERAGE, POLICY, OR CERTIFICATE SHALL:

(I) CLEARLY INDICATE THE OFFICE WITHIN THE DEPARTMENT OF
HEALTH AND MENTAL HYGIENE OR THE ADMINISTRATION THAT IS RESPONSIBLE
FOR RECEIVING AND RESPONDING TO ENROLLEE'S COMPLAINTS CONCERNING
CARRIERS; AND SHALL

               (II) INCLUDE THE TELEPHONE NUMBER OF THE OFFICE AND THE

PROCESS FOR FILING A COMPLAINT.

(K) THE COMMISSIONER SHALL:

(1) ADOPT REGULATIONS CONCERNING THE APPLICATION PROCESS
THAT CARRIERS SHALL USE TO PROCESS APPLICATIONS FOR PARTICIPATION IN A
CARRIER'S PROVIDER PANEL; AND

(2) JOINTLY IN CONSULTATION WITH THE SECRETARY OF HEALTH AND
MENTAL HYGIENE, ADOPT STRATEGIES THAT WOULD ASSIST CARRIERS IN
MAXIMIZING THE OPPORTUNITY OF A BROAD RANGE OF MINORITY PROVIDERS TO
PARTICIPATE IN THE DELIVERY OF HEALTH CARE SERVICES.

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