Ch. 604

1995 LAWS OF MARYLAND

(4) "PROVIDER PANEL" MEANS THOSE PROVIDERS WITH WHICH A
HEALTH MAINTENANCE ORGANIZATION CONTRACTS TO PROVIDE HEALTH CARE
SERVICES TO THE HEALTH MAINTENANCE ORGANIZATION'S MEMBERS OR
SUBSCRIBERS UNDER THE HEALTH MAINTENANCE ORGANIZATION'S HEALTH
BENEFIT PLAN.

(B) IF AN EMPLOYER, ASSOCIATION, OR OTHER PRIVATE GROUP
ARRANGEMENT OFFERS HEALTH BENEFIT PLAN COVERAGE TO EMPLOYEES OR
INDIVIDUALS ONLY THROUGH A HEALTH MAINTENANCE ORGANIZATION, THE
HEALTH MAINTENANCE ORGANIZATION WITH WHICH THE EMPLOYER,
ASSOCIATION, OR OTHER PRIVATE GROUP ARRANGEMENT IS CONTRACTING FOR
THE COVERAGE SHALL OFFER, OR CONTRACT WITH ANOTHER CARRIER TO OFFER,
A POINT-OF-SERVICE OPTION TO THE EMPLOYER, ASSOCIATION, OR OTHER PRIVATE
GROUP ARRANGEMENT IN CONJUNCTION WITH THE HEALTH MAINTENANCE
ORGANIZATION AS AN ADDITIONAL BENEFIT FOR AN EMPLOYEE OR INDIVIDUAL,
AT THE EMPLOYEE'S OR INDIVIDUAL'S OPTION, TO ACCEPT OR REJECT.

(C) (1) AN EMPLOYER, ASSOCIATION, OR OTHER PRIVATE GROUP
ARRANGEMENT MAY REQUIRE AN EMPLOYEE OR INDIVIDUAL THAT ACCEPTS THE
ADDITIONAL COVERAGE UNDER A POINT-OF-SERVICE OPTION UNDER SUBSECTION
(B) OF THIS SECTION TO BE RESPONSIBLE FOR THE PAYMENT OF A PREMIUM OVER
THE AMOUNT OF THE PREMIUM FOR THE COVERAGE OFFERED BY THE HEALTH
MAINTENANCE ORGANIZATION.

(2) A CARRIER MAY IMPOSE DIFFERENT COST SHARING PROVISIONS
FOR THE POINT-OF-SERVICE OPTION BASED ON WHETHER THE HEALTH CARE
SERVICE IS PROVIDED THROUGH THE PROVIDER PANEL OF THE HEALTH
MAINTENANCE ORGANIZATION OR OUTSIDE THE PROVIDER PANEL OF THE HEALTH
MAINTENANCE ORGANIZATION.

SECTION 3. AND BE IT FURTHER ENACTED, That:

(a)     The Secretary of Health and Mental Hygiene, jointly with the Dean of the
University of Maryland School of Medicine, the Dean of The Johns Hopkins University School
of Medicine, and the President of the Monumental Medical Society, shall conduct a study to
determine if there is a need in Maryland to require all health care practitioners authorized
under the Health Occupations Article to participate in the Maryland Medical Assistance
Program as a condition of licensure or certification;

(b)     The study shall include information on:

(1) Whether there is an underserved population of medically indigent individuals
who are categorically eligible for Medical Assistance benefits, including:

(i) The geographical area of the underserved population;

(ii) The reasons why the population is underserved; and

(iii) The type and number of health care practitioners needed to meet the
needs of the underserved population; and

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