PARRIS N. GLENDENING, Governor

S.B. 624

CONDUCT OF ANY OTHER PERSON OTHER THAN THE HEALTH CARE PROVIDER OR
THE HEALTH CARE PROVIDER'S AGENTS OR EMPLOYEES A COVERAGE DECISION OR
NEGLIGENT ACT OF THE INSURER.

490DD.

(a)     (1) In this section the following words have the meanings indicated.

(2)     "Carrier" means:                                                                         
(i) An insurer;

(ii) A nonprofit health service plan;

(iii) A health maintenance organization;

(iv) A dental plan organization; or

(v) Any other person or organization that provides health benefit
plans subject to State regulation.

(3)     "Health care practitioner" means any individual who is licensed,
certified, or otherwise authorized under the Health Occupations Article to provide health
care services.

(b)     A carrier [that reimburses a health care practitioner on an aggregate fixed
sum basis or on a per capita basis] may not reimburse [the] A health care practitioner in
an amount less than the sum or rate negotiated in the carrier's provider contract with the
health care practitioner.

(C) THIS SECTION APPLIES TO ANY METHOD OF REIMBURSEMENT USED BY A
CARRIER TO REIMBURSE A HEALTH CARE PRACTITIONER, INCLUDING
REIMBURSEMENT MADE ON A CAPITATED OR NONCAPITATED BASIS.

[(c)](D) This section does not prohibit a carrier from providing bonuses or other
incentive-based compensation to a health care practitioner if the bonus or other
incentive-based compensation does not:

(1)     Violate the provisions of § 19-705.1 of the Health - General Article; or

(2)     Deter the delivery of medically appropriate care to an enrollee.
490FF.

(A) (1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS
INDICATED.

(2) "CARRIER" MEANS:

(I)      AN INSURER;

(II)    A NONPROFIT HEALTH SERVICE PLAN;
(III) A HEALTH MAINTENANCE ORGANIZATION;
(IV) A DENTAL PLAN ORGANIZATION; OR

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