PARRIS N. GLENDENING, Governor

Ch. 605

(F) (G) EACH CARRIER SHALL ESTABLISH AN INTERNAL REVIEW SYSTEM
TO RESOLVE AN APPEAL BY A PROVIDER OF A TERMINATION OF THE PROVIDER
FROM PARTICIPATION IN THE CARRIER'S PROVIDER PANEL.

(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

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

(H) (I) (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 PROVIDERS IN ITS PROVIDER PANEL; AND

(II) INFORMATION WITH RESPECT TO 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.

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

(I) CLEARLY INDICATE THE OFFICE WITHIN THE
ADMINISTRATION THAT IS RESPONSIBLE FOR RECEIVING AND RESPONDING TO
ENROLLEE'S COMPLAINTS CONCERNING CARRIERS; AND

(II) SHALL INCLUDE THE TELEPHONE NUMBER OF THE OFFICE
AND THE PROCESS FOR FILING A COMPLAINT.

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

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

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

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