PARRIS N. GLENDENING, Governor

Ch. 352

(k) The Commissioner shall:

(1) Adopt regulations concerning the application process that carriers shall use
to process applications for participation in a carrier's provider panel; and

(2) In consultation with the Secretary of Health and Mental Hygiene, adopt
strategies that would assist carriers in maximizing the opportunity of a broad range of minority
providers to participate in the delivery of health care services.

490FF.

A CARRIER AS DEFINED IN § 490CC OF THIS ARTICLE THAT OPERATES A MANAGED
CARE ORGANIZATION UNDER TITLE IS, SUBTITLE I OF THE HEALTH - GENERAL
ARTICLE MAY NOT DENY, LIMIT OR OTHERWISE IMPAIR THE PARTICIPATION OF A
PROVIDER UNDER CONTRACT WITH THE CARRIER FOR CHOOSING NOT TO PARTICIPATE
OR LIMITING PARTICIPATION IN THE CARRIERS MANAGED CARE ORGANIZATION IF THE
CARRIER IS IN VIOLATION OF § 15-102.4 OF THE HEALTH- GENERAL ARTICLE.

Article - Health - General

15-101.

(a)     In this title the following words have the meanings indicated.

(B) "ENROLLEE" MEANS A PROGRAM RECIPIENT WHO IS ENROLLED IN A
MANAGED CARE ORGANIZATION.

(C) "EXCEPTIONAL NEEDS CARE COORDINATOR" MEANS A PERSON
EMPLOYED BY THE MANAGED CARE ORGANIZATION TO ASSIST INDIVIDUALS IN
SPECIAL NEEDS POPULATIONS TO ACCESS. COORDINATE. AND OBTAIN SERVICES
THAT MEET THE INDIVIDUALS' NEEDS.

(b)    (D) (C) "Facility" means a hospital or nursing facility including an
intermediate care facility, skilled nursing facility, comprehensive care facility, or extended
care facility.

(E) (D) (1) "HISTORIC PROVIDER" MEANS A HEALTH CARE PROVIDER, AS
DEFINED IN § 19-1501 OF THIS ARTICLE. WHOSE PATIENT PROFILE HAS INCLUDED A
SUBSTANTIAL NUMBER, AS IDENTIFIED BY THE DEPARTMENT IN REGULATION OF
PROGRAM RECIPIENTS FOR AT LEAST 5 YEARS.

(2) "HISTORIC PROVIDER" INCLUDES. TO THE EXTENT THAT THE
PROVIDER'S PATIENT PROFILE MEETS THE REQUIREMENTS OF PARAGRAPH (1) OF
TIBS SUBSECTION, ACADEMIC HEALTH CENTERS. OUTPATIENT PROGRAMS OWNED
OR CONTROLLED BY HOSPITALS, COMMUNITY HEALTH CENTERS, SCHOOL-BASED
HEALTH CLINICS, LOCAL HEALTH DEPARTMENTS. AND PHARMACIES. WHO, ON OR
BEFORE JUNE 30, 1995, HAD A DEMONSTRATED HISTORY OF PROVIDING SERVICES TO
PROGRAM RECIPIENTS, AS DEFINED BY THE DEPARTMENT IN REGULATIONS.

(2) "HISTORIC PROVIDER", TO THE EXTENT THE PROVIDER MEETS THE
REQUIREMENTS IN PARAGRAPH (1) OF THIS SUBSECTION. SHALL INCLUDE:

(I) A FEDERAL OR STATE QUALIFIED COMMUNITY HEALTH CENTER;

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