clear space clear space clear space white space
A
 r c h i v e s   o f   M a r y l a n d   O n l i n e
  Maryland State Archives | Index | Help | Search search for:
clear space
white space
Session Laws, 1995
Volume 793, Page 3454   View pdf image
 Jump to  
  << PREVIOUS  NEXT >>
clear space clear space clear space white space

Ch. 605                                        1995 LAWS OF MARYLAND

(3) "CRITERIA" MEANS A SYSTEM, PLAN, METHODOLOGY, PROVIDER
PROFILE, OR STANDARD USED BY A CARRIER TO SELECT OR DENY PROVIDERS
THAT HAVE APPLIED TO BECOME MEMBERS OF THE CARRIER'S PROVIDER PANEL.

(4) "ENROLLEE" MEANS ANY PERSON ENTITLED TO HEALTH CARE
BENEFITS FROM A CARRIER.

(5) "PARTICIPATING PROVIDER" MEANS ANY PROVIDER THAT HAS
ENTERED INTO A WRITTEN PROVIDER SERVICE CONTRACT WITH A CARRIER TO
PROVIDE SERVICES UNDER THE CARRIER'S HEALTH BENEFIT PLAN.

(6) (I) "PROVIDER" MEANS A PERSON LICENSED, CERTIFIED, OR
OTHERWISE AUTHORIZED UNDER THE HEALTH OCCUPATIONS ARTICLE TO
PROVIDE HEALTH CARE SERVICES.

(II) "PROVIDER" INCLUDES A HEALTH CARE FACILITY,

PHARMACY, PROFESSIONAL SERVICE CORPORATION, PARTNERSHIP, LIMITED
LIABILITY COMPANY, PROFESSIONAL OFFICE, OR ANY OTHER ENTITY LICENSED OR
AUTHORIZED BY LAW TO PROVIDE OR DELIVER PROFESSIONAL SERVICES
THROUGH OR ON BEHALF OF A PROVIDER.

(7) "PROVIDER PANEL" MEANS A GROUP OF PROVIDERS THAT HAVE
ENTERED INTO A WRITTEN PROVIDER SERVICE CONTRACT WITH A CARRIER TO
PROVIDE SERVICES UNDER THE CARRIER'S HEALTH BENEFIT PLAN.

(B) A CARRIER SHALL PROVIDE HEALTH CARE SERVICES TO ENROLLEES IN
ACCORDANCE WITH THE PROVISIONS OF § 657 OF THIS ARTICLE.

(C) (1) A CARRIER THAT USES A PROVIDER PANEL SHALL:

(I) ESTABLISH REASONABLE CRITERIA FOR PARTICIPATION ON
THE CARRIER'S PROVIDER PANEL;

(II) ESTABLISH REASONABLE PROCEDURES FOR THE REVIEW OF
APPLICATIONS FOR MEMBERSHIP ON THE CARRIER'S PROVIDER PANEL;

(III) REVIEW APPLICATIONS SUBMITTED TO PROVIDERS APPLYING
FOR MEMBERSHIP OR CONTINUED MEMBERSHIP ON A CARRIER'S PROVIDER PANEL
IN ACCORDANCE WITH THIS SECTION; AND

(IV) MAINTAIN THE CRITERIA AND PROCEDURES AT A LOCATION
IN THE STATE AND MAKE THE CRITERIA AVAILABLE TO THE PUBLIC UPON
REQUEST.

(2) (I) THE COMMISSIONER AND THE SECRETARY OF HEALTH AND
MENTAL HYGIENE JOINTLY SHALL ADOPT REGULATIONS FOR:

1. THE FILING OF CRITERIA AND PROCEDURES WITH THE
STATE; AND

2. THEIR INSPECTION AND REVIEW BY THE PUBLIC.

- 3454 -

 

clear space
clear space
white space

Please view image to verify text. To report an error, please contact us.
Session Laws, 1995
Volume 793, Page 3454   View pdf image
 Jump to  
  << PREVIOUS  NEXT >>


This web site is presented for reference purposes under the doctrine of fair use. When this material is used, in whole or in part, proper citation and credit must be attributed to the Maryland State Archives. PLEASE NOTE: The site may contain material from other sources which may be under copyright. Rights assessment, and full originating source citation, is the responsibility of the user.


Tell Us What You Think About the Maryland State Archives Website!



An Archives of Maryland electronic publication.
For information contact mdlegal@mdarchives.state.md.us.

©Copyright  August 17, 2024
Maryland State Archives