(3) (I) "MEMBER" MEANS AN INDIVIDUAL ENTITLED TO HEALTH CARE
BENEFITS UNDER A POLICY; OR PLAN, OR CERTIFICATE ISSUED OR DELIVERED IN
THE STATE BY A CARRIER

(II) "MEMBER" INCLUDES A SUBSCRIBER

(4) "PROVIDER PANEL" MEANS THOSE PROVIDERS WITH WHICH A
CARRIER CONTRACTS TO PROVIDE SERVICES TO ITS MEMBERS.

(5) "SPECIALIST" MEANS A PHYSICIAN WHO IS NOT A PRIMARY CARE
PROVIDER "SPECIALIST" MEANS AN INDIVIDUAL WHO:

(I) IS LICENSED, CERTIFIED, OR OTHERWISE AUTHORIZED UNDER
THE HEALTH OCCUPATIONS ARTICLE TO PROVIDE HEALTH CARE IN THE ORDINARY
COURSE OF BUSINESS OR PRACTICE OF A PROFESSION; AND

(II) IS NOT A PRIMARY CARE PHYSICIAN, " SPECIALIST" MEANS A
PHYSICIAN WHO IS CERTIFIED OR TRAINED TO PRACTICE IN A SPECIFIED FIELD OF
MEDICINE AND WHO IS NOT DESIGNATED AS A PRIMARY CARE PROVIDER BY THE
CARRIER

(B) (1) EACH CARRIER THAT DOES NOT ALLOW DIRECT ACCESS TO
SPECIALISTS SHALL ESTABLISH AND IMPLEMENT A PROCEDURE BY WHICH A
MEMBER MAY RECEIVE A STANDING REFERRAL TO A SPECIALIST IN ACCORDANCE
WITH THIS SUBSECTION.

(2) THE PROCEDURE SHALL PROVIDE FOR A STANDING REFERRAL TO A
SPECIALIST IF:

(I) THE PRIMARY CARE PROVIDER PHYSICIAN OF THE MEMBER
DETERMINES, IN CONSULTATION WITH THE SPECIALIST, THAT THE MEMBER NEEDS
CONTINUING CARE FROM THE SPECIALIST;

(II) THE MEMBER HAS A CONDITION OR DISEASE THAT:

1. IS LIFE THREATENING, DEGENERATIVE, CHRONIC, OR

DISABLING; AND

2. REQUIRES SPECIALIZED MEDICAL CARE; AND

(III) THE SPECIALIST:

1. HAS EXPERTISE IN TREATING THE LIFE-THREATENING,
DEGENERATIVE, CHRONIC, OR DISABLING DISEASE OR CONDITION; AND

2. IS PART OF THE CARRIER'S PROVIDER PANEL.

(3) A STANDING REFERRAL SHALL BE MADE IN ACCORDANCE WITH A
WRITTEN TREATMENT PLAN THAT IS APPROVED BY THE CARRIER IN CONSULTATION
WITH: FOR A COVERED SERVICE DEVELOPED BY:

(I) THE PRIMARY CARE PROVIDER PHYSICIAN;

(II) THE SPECIALIST; AND