PARRIS N. GLENDENING, Governor                             S.B. 624

ENROLLEE PUBLIC OFFICIAL SUBSCRIBER OR OTHER PERSON INFORMATION THAT
IS NECESSARY OR APPROPRIATE FOR THE DELIVERY OF HEALTH CARE SERVICES,
INCLUDING:

(1) COMMUNICATIONS RELATING TO TREATMENT ALTERNATIVES;

(2) COMMUNICATIONS NECESSARY OR APPROPRIATE TO MAINTAIN
THE PROVIDER-PATIENT RELATIONSHIP WHILE THE PATIENT IS UNDER THE
PROVIDER'S CARE;

(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 DOES 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 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, "ECONOMIC PRACTICE PROFILE" MEANS A
PROFILE, SUMMARY, OR ECONOMIC ANALYSIS, OR OTHER ANALYSIS OF DATA
CONCERNING SERVICES RENDERED OR UTILIZED BY A PROVIDER THAT IS UNDER
CONTRACT WITH OR EMPLOYED BY A HEALTH MAINTENANCE ORGANIZATION IN
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 AN ECONOMIC A
PRACTICE PROFILE AS A FACTOR IN ITS PEER REVIEW, QUALITY ASSURANCE,
CONTRACT REVIEW, OR OTHER PROVIDER REVIEW PROGRAM TO EVALUATE THE
PROVIDER TO EVALUATE A PROVIDER'S STATUS ON A PROVIDER PANEL THE
HEALTH MAINTENANCE ORGANIZATION SHALL DISCLOSE AND PROVIDE TO A
PROVIDER ON REQUEST:

(I) THE DATA AND AT THE COMMENCEMENT AND RENEWAL OF
THE CONTRACT AND, NOT MORE OFTEN THAN ANNUALLY, UPON THE REQUEST OF
THE PROVIDER:

(I) A DESCRIPTION OF THE CRITERIA USED TO COMPILE THE
ECONOMIC PRACTICE PROFILE CONCERNING THE PROVIDER; AND

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