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PARRIS N. GLENDENING, Governor Ch. 253
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2. a nonprofit health service plan;
3. a health maintenance organization;
4. a dental plan organization; or
5. any other person that provides health benefit plans
subject to regulation by the State.
(ii) "Carrier" includes an entity that arranges a provider panel for a
carrier.
(3) "Enrollee" means a person entitled to health care benefits from a
carrier.
(4) "Provider" means a health care practitioner or group of health care
practitioners licensed, certified, or otherwise authorized by law to provide health care
services.
(5) (i) "Provider panel" means the providers that contract with a
carrier to provide health care services to the carrier's enrollees under the carrier's
health benefit plan.
(ii) "Provider panel" does not include an arrangement in which any
provider may participate solely by contracting with the carrier to provide health care
services at a discounted fee-for—service rate.
(L) (1) (I) IN THIS SUBSECTION THE FOLLOWING WORDS HAVE THE
MEANINGS INDICATED.
(II) "HEALTH BENEFIT PLAN" HAS THE MEANING STATED IN §
15-1201 OF THIS TITLE.
(III) "PROVIDER PANEL" INCLUDES AN ARRANGEMENT IN WHICH
ANY PROVIDER MAY PARTICIPATE SOLELY BY CONTRACTING WITH THE CARRIER TO
PROVIDE HEALTH CARE SERVICES AT A DISCOUNTED FEE-FOR-SERVICE RATE.
(2) EXCEPT AS PROVIDED IN PARAGRAPH (3) OF THIS SUBSECTION, A
CARRIER THAT OFFERS COVERAGE FOR HEALTH CARE SERVICES THROUGH ONE OR
MORE HEALTH BENEFIT PLANS OR CONTRACTS WITH PROVIDERS TO OFFER HEALTH
CARE SERVICES THROUGH ONE OR MORE PROVIDER PANELS MAY NOT REQUIRE A
PROVIDER, AS A CONDITION OF PARTICIPATION OR CONTINUATION ON A PROVIDER
PANEL FOR ONE HEALTH BENEFIT PLAN OF A CARRIER, TO SERVE ALSO ON A
PROVIDER PANEL OF ANOTHER HEALTH BENEFIT PLAN OF THE CARRIER
(3) SUBJECT TO § 15-102.5 OF THE HEALTH - GENERAL ARTICLE, A
CARRIER THAT OFFERS HEALTH CARE SERVICES AS A MANAGED CARE
ORGANIZATION AS DEFINED UNDER § 15-101(F) OF THE HEALTH- GENERAL ARTICLE.
MAY REQUIRE A PROVIDER AS A CONDITION OF PARTICIPATION ON A PROVIDER
PANEL FOR ONE OR MORE HEALTH BENEFIT PLANS OF THE CARRIER TO SERVE ON A
PROVIDER PANEL OF THE MANAGED CARE ORGANIZATION.
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