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PARRIS N. GLENDENING, Governor Ch. 565
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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.
(b) (1) The Maryland Health Care Commission shall adopt regulations that
specify a plan for substantial, available, and affordable coverage that shall be offered
in the nongroup market by a carrier that qualifies for an approved purchaser
differential under regulations adopted by the Health Services Cost Review
Commission.
(2) In establishing a plan under this subsection, the Maryland Health
Care Commission shall judge preventive services, medical treatments, procedures,
and related health services based on:
(i) their effectiveness in improving the health of individuals;
(ii) their impact on maintaining and improving health and
encouraging consumers to use only the health care services they need; and
(iii) their impact on the affordability of health care coverage.
(3) The Maryland Health Care Commission may exclude from the plan:
(i) a health care service, benefit, coverage, or reimbursement for
covered health care services that is required under this article or the Health -
General Article to be provided or offered in a health benefit plan that is issued or
delivered in the State by a carrier; or
(ii) reimbursement required by statute, by a health benefit plan for
a service when that service is performed by a health care provider who is licensed
under the Health Occupations Article and whose scope of practice includes that
service.
(4) The plan shall include uniform deductibles and cost-sharing
associated with its benefits, as determined by the Maryland Health Care
Commission.
(5) In establishing cost-sharing as part of the plan, the Maryland Health
Care Commission shall:
(i) include cost-sharing and other incentives to help consumers
use only the health care services they need;
(ii) balance the effect of cost-sharing in reducing premiums and in
affecting utilization of appropriate services; and
(iii) limit the total cost-sharing that may be incurred by an
individual in a year.
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