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Session Laws, 1995
Volume 793, Page 3455   View pdf image
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PARRIS N. GLENDENING, Governor                                 Ch. 605

(II) THE REGULATIONS ADOPTED UNDER THIS SUBSECTION SHALL
INCLUDE PROVISIONS FOR THE UPDATING AND FILING OF ALL AMENDMENTS TO
EACH CARRIER'S CRITERIA AND PROCEDURES.

(D) (1) A CARRIER THAT USES A PROVIDER PANEL SHALL PROVIDE THE
CRITERIA AND PROCEDURES ESTABLISHED UNDER SUBSECTION (C) OF THIS
SECTION TO ANY PROVIDER REQUESTING AN APPLICATION FOR MEMBERSHIP ON A
CARRIER'S PROVIDER PANEL.

(2) AFTER REVIEW BY A CARRIER OF AN APPLICATION;

(I) THE CARRIER MAY:

1. ACCEPT THE PROVIDER AS A MEMBER OF ITS PROVIDER
PANEL; OR

2. SUBJECT TO PARAGRAPH (3) OF THIS SUBSECTION,
REJECT THE PROVIDER AS A MEMBER OF THE PROVIDER PANEL; AND

(II) IF THE APPLICATION IS REJECTED, THE CARRIER SHALL
INFORM THE PROVIDER IN WRITING OF THE CRITERIA ON WHICH THE REJECTION
WAS BASED AND THE SPECIFIC FACTUAL BASIS FOR ITS REJECTION.

(3) (I) A CARRIER SHALL GIVE NOTICE OF THE ACCEPTANCE OR
DENIAL OF A COMPLETED APPLICATION WITHIN 30 DAYS OF RECEIPT OF THE
APPLICATION.

(II) SUBJECT TO PARAGRAPH (2)(II) OF THIS SUBSECTION, A
CARRIER SHALL HOLD CONFIDENTIAL ALL NOTICES OF DENIAL AND THE CRITERIA
APPLIED IN REJECTING AN APPLICATION.

(III) THE FAILURE OF A CARRIER TO ACCEPT OR DENY AN
APPLICATION WITHIN 30 DAYS OF RECEIPT OF AN APPLICATION SHALL BE DEEMED
AN ACCEPTANCE.

(4) A CARRIER MAY NOT DENY PARTICIPATION ON ITS PROVIDER
PANEL ON THE BASIS OF GENDER, RACE, AGE, RELIGION, NATIONAL ORIGIN, OR
DISABILITY.

(5) A CARRIER MAY NOT RESTRICT OR TERMINATE A PROVIDER'S
PARTICIPATION ON ITS PROVIDER PANEL SOLELY ON THE BASIS OF:

(I) THE TYPE OR NUMBER OF APPEALS FILED BY THE PROVIDER

UNDER THE PROVISIONS OF TITLE 19, SUBTITLE 13 OF THE HEALTH - GENERAL

ARTICLE;

(II) ANY OTHER COMPLAINT OR GRIEVANCE, OR THE NUMBER OF
COMPLAINTS OR GRIEVANCES, THE PROVIDER HAS FILED WITH THE CARRIER; OR

(III) THE DEGREE HELD BY THE PROVIDER.

- 3455 -

 

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Session Laws, 1995
Volume 793, Page 3455   View pdf image
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