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H.B.1157
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VETOES
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[(5)](6) "Provider panel" means the providers that contract with a
carrier to provide health care services to the enrollees under a health benefit plan of
the carrier.
[(6)](7) "Uniform credentialing form" means the form designated by the
Commissioner through regulation for use by a [carrier or] CARRIER, its credentialing
[intermediary] INTERMEDIARY, OR A HEALTH CARE FACILITY for credentialing and
recredentialing a health care provider for participation on a provider panel OR FOR
STAFF PRIVILEGES AT A HEALTH CARE FACILITY.
(B) THE UNIFORM CREDENTIALING FORM SHALL PROVIDE FOR THE
COLLECTION OF ALL INFORMATION THAT CARRIERS, CREDENTIALING
INTERMEDIARIES AND HEALTH CARE FACILITIES ARE REQUIRED TO COLLECT IN
ORDER TO MEET THEIR CREDENTIALING RESPONSIBILITIES UNDER STATE AND
FEDERAL LAW, AND ALL INFORMATION REQUIRED BY A HEALTH CARE FACILITY FOR
PURPOSES OF GRANTING STAFF PRIVILEGES.
[(b)] (C) (1) A carrier or its credentialing intermediary shall accept the
uniform credentialing form as the sole application for a health care provider to
become credentialed or recredentialed for a provider panel of the carrier;
(2) A HEALTH CARE FACILITY SHALL ACCEPT THE UNIFORM
CREDENTIALING FORM AS THE SOLE APPLICATION FOR A HEALTH CARE PROVIDER
[(2)](3) A carrier or its credentialing intermediary shall make the
uniform credentialing form available to any health care provider that is to be
credentialed or recredentialed by that carrier or credentialing intermediary OR BY A
HEALTH CARE FACILITY.
[(c)] (D) The Commissioner may impose a penalty not to exceed $500 against
any carrier for each violation of this section by the [carrier or] CARRIER, its
credentialing intermediary, OR HEALTH CARE FACILITY.
[(d)](E) (1) The Commissioner shall adopt regulations to implement the
provisions of this section.
(2) In adopting the regulations required under paragraph (1) of this
subsection, the Commissioner shall consider the use of an electronic format for the
uniform credentialing form and the filing of the uniform credentialing form by
electronic means.
SECTION 2. AND BE IT FURTHER ENACTED, That until ouch time as the
Insurance Commissioner, in collaboration with the Secretary of Health and Mental
Hygiene, has revised the regulations to meet the new requirements of this Act, may
permit a carrier may to use a health care facility's credentialing form to credential
providers at that facility instead of the uniform form, if the carrier has designated the
health care facility as the credentialing intermediary for the health care facility's
physicians.
SECTION 3. AND BE IT FURTHER ENACTED, That, in modifying the
uniform credentialing form to reflect the new requirements in this Act, the Insurance
Commissioner in collaboration with the Secretary of Health and Mental Hygiene,
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- 5330 -
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