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PARRIS N. GLENDENING, Governor
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Ch. 323
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(B) "CONTRACTING PROVIDER" MEANS A PHYSICIAN OR OTHER HEALTH CARE
PROVIDER WHO ENTERS INTO AN ADMINISTRATIVE SERVICE PROVIDER CONTRACT
WITH A HEALTH MAINTENANCE ORGANIZATION OR A LICENSED HEALTH SERVICES
CONTRACTOR.
(E) "DOWNSTREAM RISK ASSUMPTION CONTRACT" MEANS A CONTRACT OR
AGREEMENT, INCLUDING AN ADMINISTRATIVE SERVICE PROVIDER CONTRACT, FOR
HEALTH CARE SERVICES TO BE PROVIDED TO A MEMBER OF A HEALTH
MAINTENANCE ORGANIZATION WITH PAYMENT TO BE MADE ON A CAPITATED BASIS
THAT INCLUDES REQUIREMENTS THAT-
(1) THE NUMBER OF MEMBERS TO RECEIVE HEALTH CARE SERVICES
PER MONTH EXCEEDS 100 INDIVIDUALS; OR
(2) THE CAPITATION AMOUNT TO BE RECEIVED MEETS OR EXCEEDS
$50,000 PER MONTH.
(F) "EXTERNAL PROVIDER" MEANS A HEALTH CARE PROVIDER, INCLUDING A
PHYSICIAN OR HOSPITAL, WHO IS NOT;
(1) A CONTRACTING PROVIDER; OR
(2) AN EMPLOYEE, SHAREHOLDER, OR PARTNER OF A CONTRACTING
PROVIDER.
"HEALTH CARE SERVICES" HAS THE MEANING STATED IN § 19-701(E) OF
THE HEALTH - GENERAL ARTICLE AND INCLUDES ANY HEALTH OR MEDICAL
PROCEDURE OR SERVICE RENDERED BY A HEALTH CARE PROVIDER THAT:
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(1) PROVIDES TESTING, DIAGNOSIS, OR TREATMENT OF A HUMAN
DISEASE OR DYSFUNCTION; OR
(2) DISPENSES DRUGS, MEDICAL DEVICES, MEDICAL APPLIANCES, OR
MEDICAL GOODS FOR THE TREATMENT OF A HUMAN DISEASE OR DYSFUNCTION.
(H) "HEALTH MAINTENANCE ORGANIZATION" HAS THE MEANING STATED IN §
19-701(F) OF THE HEALTH - GENERAL ARTICLE.
(I) "LICENSED HEALTH SERVICES CONTRACTOR" MEANS AN ENTITY OR
PROVIDER THAT IS LICENSED BY THE COMMISSIONER IN ACCORDANCE WITH THE
REQUIREMENTS OF THIS SUBTITLE.
(J) "MEMBER" HAS THE MEANING STATED IN § 19-701(C) OF THE HEALTH
GENERAL ARTICLE.
(K) "PROVIDER" MEANS ANY PERSON, INCLUDING A PHYSICIAN OR HOSPITAL,
THAT IS LICENSED OR OTHERWISE AUTHORIZED IN THIS STATE TO PROVIDE HEALTH
CARE SERVICES.
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- 1935 -
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