PARRIS N. GLENDENING, Governor

Ch. 605

(4) "PROVIDER PANEL" MEANS THOSE PROVIDERS WITH WHICH A CARRIER
CONTRACTS TO PROVIDE DENTAL SERVICES TO THE CARRIER'S INSUREDS, ENROLLEES,
OR OTHER COVERED PERSONS UNDER THE CARRIER'S DENTAL BENEFIT PLAN.

(B) IF AN EMPLOYER, ASSOCIATION, OR OTHER PRIVATE GROUP ARRANGEMENT
OFFERS DENTAL BENEFIT PLAN COVERAGE TO EMPLOYEES OR INDIVIDUALS ONLY
THROUGH A CARRIER'S PROVIDER PANEL, THE CARRIER 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 DENTAL
POINT-OF-SERVICE OPTION TO THE EMPLOYER, ASSOCIATION, OR OTHER PRIVATE
GROUP ARRANGEMENT 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 DENTAL 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 DENTAL BENEFIT COVERAGE
OFFERED BY THE CARRIER ONLY THROUGH ITS PROVIDER PANEL.

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

SECTION 2. AND BE IT FURTHER ENACTED, That:

(a) The Insurance Administration shall study the issue of enrollee access to
providers, including:

(1) premium and out of pocket costs to enrollees;

(2) enrollee access to specialists; and

(3) the effect on minority providers of carrier criteria and procedures
established for determining participation on provider panels.

(b) On or before December 31, 1996, the Insurance Administration shall report
the findings of its study under subsection (a) of this section to the Senate Finance
Committee and the House Economic Matters Committee and submit a copy of the report
to the library of the Department of Legislative Reference.

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:

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