PARRIS N. GLENDENING, Governor

Ch. 35

THIS SECTION APPLIES TO:

(1) INSURERS AND NONPROFIT HEALTH SERVICE PLANS THAT PROVIDE
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS ON AN
EXPENSE-INCURRED BASIS UNDER HEALTH INSURANCE POLICIES THAT ARE ISSUED
OR DELIVERED IN THE STATE; AND

(2) HEALTH MAINTENANCE ORGANIZATIONS THAT PROVIDE HOSPITAL,
MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS UNDER
CONTRACTS THAT ARE ISSUED OR DELIVERED IN THE STATE.

(B) CLASSIFICATION AS PRIMARY CARE PROVIDER; ROUTINE CARE.
AN ENTITY SUBJECT TO THIS SECTION:

(1) SHALL CLASSIFY AN OBSTETRICIAN/GYNECOLOGIST AS A PRIMARY
CARE PROVIDER; OR

(2) IF THE OBSTETRICIAN/GYNECOLOGIST CHOOSES NOT TO BE A
PRIMARY CARE PROVIDER, SHALL ALLOW A WOMAN TO RECEIVE ROUTINE
GYNECOLOGICAL CARE FROM AN IN-NETWORK OBSTETRICIAN/GYNECOLOGIST
WITHOUT REQUIRING THE WOMAN TO VISIT A PRIMARY CARE PROVIDER FIRST, IF:

(I) THE CARE IS MEDICALLY NECESSARY, INCLUDING CARE THAT

IS ROUTINE;

(II) AFTER EACH VISIT FOR GYNECOLOGICAL CARE, THE
OBSTETRICIAN/GYNECOLOGIST COMMUNICATES WITH THE WOMAN'S PRIMARY
CARE PROVIDER ABOUT ANY DIAGNOSIS OR TREATMENT RENDERED; AND

(III) THE OBSTETRICIAN/GYNECOLOGIST CONFERS WITH THE
PRIMARY CARE PROVIDER BEFORE PERFORMING ANY DIAGNOSTIC PROCEDURE
THAT IS NOT ROUTINE GYNECOLOGICAL CARE RENDERED DURING AN ANNUAL
VISIT.

(C) ANNUAL VISITS TO IN-NETWORK PHYSICIANS REQUIRED.

IF AN ENTITY SUBJECT TO THIS SECTION CLASSIFIES AN
OBSTETRICIAN/GYNECOLOGIST AS A PRIMARY CARE PROVIDER AS PROVIDED IN
SUBSECTION (B) OF THIS SECTION, AND A WOMAN DOES NOT CHOOSE AN
OBSTETRICIAN/GYNECOLOGIST AS THE WOMAN'S PRIMARY CARE PROVIDER, THE
ENTITY SHALL ALLOW THE WOMAN AN ANNUAL VISIT TO AN IN-NETWORK
OBSTETRICIAN/GYNECOLOGIST FOR ROUTINE GYNECOLOGICAL CARE WITHOUT
REQUIRING THE WOMAN TO VISIT THE WOMAN'S PRIMARY CARE PROVIDER FIRST,
WHETHER OR NOT THE PRIMARY CARE PROVIDER IS QUALIFIED TO AND
REGULARLY DOES PROVIDE ROUTINE GYNECOLOGICAL CARE.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, § 490Z.

In subsection (a)(1) of this section, the reference to hospital, medical, or
surgical benefits provided "under health insurance policies" issued or
delivered in the State is added for clarity.

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