|
Ch. 548 1996 LAWS OF MARYLAND
(3) COMMUNICATIONS REGARDING AN ENROLLEE'S OR SUBSCRIBER'S
RIGHT TO APPEAL COVERAGE DETERMINATIONS OF A CARRIER WITH WHICH THE
PROVIDER OR THE ENROLLEE OR SUBSCRIBER DO NOT AGREE; AND
(4) OPINIONS AND THE BASIS OF AN OPINION REGARDING PUBLIC
POLICY ISSUES.
(C) THIS SECTION DOES NOT PROHIBIT A CARRIER, AS A CONDITION OF A
CONTRACT BETWEEN THE HEALTH CARE PROVIDER AND THE CARRIER, FROM
PROHIBITING A HEALTH CARE PROVIDER FROM COMMITTING A COMMERCIAL
TORT TORTIOUS INTERFERENCE WITH A CONTRACT AS RECOGNIZED UNDER
MARYLAND LAW.
Article - Health - General
19-706.
(L) THE PROVISIONS OF ARTICLE 48A, § 490FF OF THE CODE APPLY TO
HEALTH MAINTENANCE ORGANIZATIONS.
19-710.
(R) (1) IN THIS SUBSECTION, "PRACTICE PROFILE" MEANS A PROFILE,
SUMMARY, ECONOMIC ANALYSIS, OR OTHER ANALYSIS OF DATA CONCERNING
SERVICES RENDERED OR UTILIZED BY A PROVIDER UNDER CONTRACT WITH OR
EMPLOYED BY A HEALTH MAINTENANCE ORGANIZATION FOR THE PROVISION OF
HEALTH CARE SERVICES BY THE PROVIDER TO ENROLLEES OR SUBSCRIBERS OF
THE HEALTH MAINTENANCE ORGANIZATION.
(2) IF A HEALTH MAINTENANCE ORGANIZATION USES A PRACTICE
PROFILE AS, A FACTOR IN ITS CONTRACT REVIEW TO EVALUATE THE PROVIDER'S
STATUS ON THE PROVIDER PANEL, THE HEALTH MAINTENANCE ORGANIZATION
SHALL DISCLOSE AND PROVIDE TO A PROVIDER ON REASONABLE REQUEST:
(I) THE ANALYSIS OF DATA AND A DESCRIPTION OF THE
CRITERIA USED TO COMPILE THE PRACTICE PROFILE CONCERNING THE PROVIDER;
AND
(II) THE MANNER IN WHICH THE PRACTICE PROFILE IS USED TO
EVALUATE THE PROVIDER.
(3) UPON FURTHER WRITTEN REQUEST BY THE PROVIDER, THE
HEALTH MAINTENANCE ORGANIZATION SHALL PROVIDE THE PROVIDER WITH THE
PROVIDER'S INDIVIDUAL INFORMATION THAT WAS UTILIZED IN COMPILING THE
PRACTICE PROFILE UNDER PARAGRAPH (2) OF THIS SUBSECTION.
(4) THE INFORMATION PROVIDED UNDER THIS SUBSECTION MAY NOT
BE USED TO CREATE A NEW CAUSE OF ACTION.
(5) A HEALTH MAINTENANCE ORGANIZATION MAY NOT TERMINATE A
PROVIDER CONTRACT OR THE PROVIDER'S EMPLOYMENT WITH THE HEALTH
- 3110 -
|
