Ch. 145

1997 LAWS OF MARYLAND

(3) "CONTRACT" MEANS ANY WRITTEN AGREEMENT BETWEEN A
PROVIDER AND A CARRIER FOR THE PROVIDER TO RENDER HEALTH CARE
SERVICES TO ENROLLEES OF THE CARRIER.

(4) "ENROLLEE" MEANS ANY PERSON OR SUBSCRIBER ENTITLED TO
HEALTH CARE BENEFITS FROM A CARRIER.

(5) "HEALTH CARE SERVICES" MEANS A HEALTH OR MEDICAL CARE
PROCEDURE OR SERVICE RENDERED BY A PROVIDER THAT:

(I) PROVIDES TESTING, DIAGNOSIS, OR TREATMENT OF A HUMAN
DISEASE OR DYSFUNCTION; OR

(II) DISPENSES DRUGS, MEDICAL DEVICES, MEDICAL APPLIANCES,
OR MEDICAL GOODS FOR THE TREATMENT OF A HUMAN DISEASE OR
DYSFUNCTION.

(6) "PRINCIPAL OPERATING PRACTICES" MEANS THE PROCESSES BY
WHICH CARRIERS MAKE DECISIONS ABOUT WHAT SERVICES TO COVER AND PAY
FOR, INCLUDING THE TITLES OF KEY ADMINISTRATIVE AND EXECUTIVE STAFF WHO
MAKE THE DECISIONS.

(7) (6) (I) "PROVIDER" MEANS A PERSON OR ENTITY LICENSED,
CERTIFIED, OR OTHERWISE AUTHORIZED UNDER THE HEALTH OCCUPATIONS
ARTICLE OR THE HEALTH - GENERAL ARTICLE TO PROVIDE HEALTH CARE
SERVICES.

(II) "PROVIDER" INCLUDES:

1. A HEALTH CARE FACILITY;

2. A PHARMACY;

3. A PROFESSIONAL SERVICES CORPORATION;

4. A PARTNERSHIP;

5. A LIMITED LIABILITY COMPANY;

6. A PROFESSIONAL OFFICE; OR

7. ANY OTHER ENTITY LICENSED OR AUTHORIZED BY LAW
TO PROVIDE OR DELIVER PROFESSIONAL HEALTH CARE SERVICES THROUGH OR
ON BEHALF OF A PROVIDER.

(B) THIS SECTION APPLIES TO A CARRIER THAT PROVIDES HEALTH-CARE
SERVICES TO ENROLLEES, OR OTHERWISE MAKES HEALTH CARE SERVICES
AVAILABLE TO ENROLLEES, THROUGH CONTRACTS WITH PROVIDERS.

(C) (1) EACH CARRIER SHALL DISCLOSE ITS PRINCIPAL OPERATING
PRACTICES, AS IDENTIFIED IN PARAGRAPH (2) OF THIS SUBSECTION:

(I) TO AN ENROLLEE OF THE CARRIER;

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