PARRIS N. GLENDENING, Governor

Ch. 35

(3) A VIOLATION OF THIS SUBSECTION DOES NOT CREATE A NEW
CAUSE OF ACTION.

(G) SAME — ADVOCATING PATIENT INTERESTS AND FILING APPEALS.

A CARRIER MAY NOT TERMINATE PARTICIPATION ON ITS PROVIDER PANEL OR
OTHERWISE PENALIZE A PROVIDER FOR;

(1) ADVOCATING THE INTERESTS OF A PATIENT THROUGH THE
CARRIER'S INTERNAL REVIEW SYSTEM ESTABLISHED UNDER SUBSECTION (H) OF
THIS SECTION; OR

(2) FILING AN APPEAL UNDER TITLE 19, SUBTITLE 13 OF THE HEALTH -
GENERAL ARTICLE.

(H) INTERNAL REVIEW SYSTEM FOR GRIEVANCES.

EACH CARRIER SHALL ESTABLISH AN INTERNAL REVIEW SYSTEM TO RESOLVE
GRIEVANCES INITIATED BY PROVIDERS THAT PARTICIPATE ON THE CARRIER'S
PROVIDER PANEL, INCLUDING GRIEVANCES INVOLVING THE TERMINATION OF A
PROVIDER FROM PARTICIPATION ON THE CARRIER'S PROVIDER PANEL.

(I) CONTINUED CARE OF ENROLLEES AFTER PROVIDER TERMINATION.

(1) FOR AT LEAST 90 DAYS AFTER THE DATE OF THE NOTICE OF
TERMINATION OF A PRIMARY CARE PROVIDER FROM A CARRIER'S PROVIDER
PANEL FOR REASONS UNRELATED TO FRAUD, PATIENT ABUSE, INCOMPETENCY, OR
LOSS OF LICENSURE STATUS, THE PRIMARY CARE PROVIDER SHALL FURNISH
HEALTH CARE SERVICES TO EACH ENROLLEE:

(I) WHO WAS RECEIVING HEALTH CARE SERVICES FROM THE
PRIMARY CARE PROVIDER BEFORE THE NOTICE OF TERMINATION; AND

(II) WHO, AFTER RECEIVING NOTICE UNDER SUBSECTION (B) OF
THIS SECTION OF THE TERMINATION OF THE PRIMARY CARE PROVIDER, REQUESTS
TO CONTINUE RECEIVING HEALTH CARE SERVICES FROM THE PRIMARY CARE
PROVIDER.

(2) A CARRIER SHALL REIMBURSE A PRIMARY CARE PROVIDER THAT
FURNISHES HEALTH CARE SERVICES UNDER THIS SUBSECTION IN ACCORDANCE
WITH THE PRIMARY CARE PROVIDER'S AGREEMENT WITH THE CARRIER.

(J) REQUIRED INFORMATION.

(1) A CARRIER SHALL PROVIDE TO PROSPECTIVE ENROLLEES BEFORE
ENROLLMENT AND TO EXISTING ENROLLEES AT LEAST ONCE A YEAR:

(I) A LIST OF PROVIDERS ON THE CARRIER'S PROVIDER PANEL;

AND

(II) INFORMATION ON PROVIDERS THAT ARE NO LONGER
ACCEPTING NEW PATIENTS.

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