ROBERT L. EHRLICH, JR., Governor                             Ch. 440

(2)     A health maintenance organization shall disclose, on request of a
health care provider not under written contract with the health maintenance
organization, the reimbursement rate required under paragraph (1)(ii)2 and 3 of this
subsection.

(3)     (i) Subject to subparagraph (ii) of this paragraph, a health
maintenance organization may require a trauma physician not under contract with
the health maintenance organization to submit appropriate adjunct claims
documentation and to include on the uniform claim form a provider number assigned
to the trauma physician by the health maintenance organization.

(ii) If a health maintenance organization requires a trauma
physician to include a provider number on the uniform claim form in accordance with
subparagraph (i) of this paragraph, the health maintenance organization shall assign
a provider number to a trauma physician not under contract with the health
maintenance organization at the request of the physician.

(4)     A trauma center, on request from a health maintenance organization,
shall verify that a licensed physician is credentialed or otherwise designated by the
trauma center to provide trauma care.

(5)      NOTWITHSTANDING THE PROVISIONS OF § 19-701(D) OF THIS
SUBTITLE, FOR TRAUMA CARE RENDERED TO A TRAUMA PATIENT IN A TRAUMA
CENTER BY A TRAUMA PHYSICIAN, A HEALTH MAINTENANCE ORGANIZATION MAY
NOT REQUIRE A REFERRAL OR PREAUTHORIZATION FOR A SERVICE TO BE COVERED.

SECTION 4. AND BE IT FURTHER ENACTED, That the Laws of Maryland
read as follows:

Article - Health - General

19-710.1.

(a) (1) In this section the following words have the meanings indicated.

(2)     "Enrollee" means a subscriber or member of the health maintenance
organization.

(3)     ["Covered service" means a health care service included in the
benefit package of the health maintenance organization and rendered to an enrollee
of the health maintenance organization by a health care provider, including a
physician or hospital, not under written contract with the health maintenance
organization:

(i) Pursuant to a verbal or written referral by the enrollee's health
maintenance organization or by a provider under written contract with the enrollee's
health maintenance organization; or

(ii) That has been preauthorized or otherwise approved either
verbally or in writing by the enrollee's health maintenance organization or a provider
under written contract with the enrollee's health maintenance organization.

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