PARRIS N. GLENDENING, Governor                             Ch. 378

(2) PROVIDING ENROLLEES WITH INFORMATION ON WHETHER THE
CARRIER COVERS AND PAYS FOR EMERGING MEDICAL AND SURGICAL
TREATMENTS AND THE BASIS FOR THE CARRIER'S POSITION; AND

(3) INFORMING ENROLLEES OF:

(I) THE PROCESS THAT THE CARRIER IS REQUIRED TO ESTABLISH
AND FOLLOW UNDER THIS SECTION IN EVALUATING EMERGING MEDICAL AND
SURGICAL TREATMENTS FOR THE PURPOSE OF DETERMINING WHETHER THE
TREATMENTS WILL BE COVERED AND PAID FOR BY THE CARRIER; AND

(II) INFORMATION THAT THE CARRIER IS REQUIRED TO DISCLOSE
AS REQUIRED UNDER THIS SECTION.

(K) (1) WHENEVER A CARRIER CONSULTS WITH OTHER CONSULTANTS OR
ORGANIZATIONS OTHER THAN THE LOCAL CLINICAL EXPERTS IDENTIFIED BY THE
CARRIER IN SUBSECTION (D) OF THIS SECTION TO EVALUATE EMERGING MEDICAL
OR SURGICAL TREATMENTS FOR THE PURPOSE OF DETERMINING WHETHER THE
TREATMENTS SHOULD BE COVERED AND PAID BY THE CARRIER, THE CARRIER
SHALL DISCLOSE IMMEDIATELY THE NAMES, AFFILIATIONS, AND ADDRESSES OF
THESE PERSONS TO THE COMMISSIONER AND THE LOCAL CLINICAL EXPERTS
IDENTIFIED BY THE CARRIER IN THE PERTINENT CLINICAL AREA.

(2)     THE INFORMATION REQUIRED TO BE DISCLOSED IN PARAGRAPH (1)
OF THIS SUBSECTION SHALL BE MADE AVAILABLE TO AN ENROLLEE UPON THE
REQUEST OF THE ENROLLEE TO THE COMMISSIONER OR THE CARRIER.

(3)     IN ADDITION TO THE INFORMATION REQUIRED TO BE DISCLOSED
UNDER PARAGRAPH (1) OF THIS SUBSECTION, THE CARRIER SHALL PROVIDE THE
FEES OR SALARIES, IF ANY, PAID BY THE CARRIER TO EACH CONSULTANT OR
ORGANIZATION.

(L) THIS SECTION DOES NOT APPLY TO ANY COSMETIC OR MEDICALLY
UNNECESSARY SERVICE OR PROCEDURE THAT TYPICALLY WOULD BE EXCLUDED
FROM COVERAGE BY THE CARRIER OR OTHER CARRIERS THAT ISSUE OR DELIVER
CONTRACTS OR POLICIES OF HEALTH INSURANCE IN THE STATE.

(M) EACH CARRIER SHALL INCLUDE IN SUMMARY FORM INFORMATION ON
THE PROCESS THAT THE CARRIER IS REQUIRED UNDER THIS SECTION TO
ESTABLISH AND FOLLOW IN EVALUATING EMERGING MEDICAL AND SURGICAL
TREATMENTS FOR THE PURPOSE OF MAKING COVERAGE AND PAYMENT DECISIONS
IN:

(1) THE MARKETING AND ENROLLMENT MATERIALS OF THE CARRIER
TO EACH CURRENT ENROLLEE AND PROSPECTIVE ENROLLEE AT THE TIME OF OPEN
ENROLLMENT OR RENEWAL; AND

(2) THE CONTRACT OR AN ATTACHMENT TO THE CONTRACT OF A
PROVIDER BEING OFFERED A CONTRACT BY THE CARRIER TO RENDER HEALTH
CARE SERVICES TO ENROLLEES OF THE CARRIER.

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