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Ch. 142
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2007 Laws of Maryland
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(v) except for a managed care organization as defined in Title
15, Subtitle 1 of the Health - General Article, any other person that provides health
benefit plans subject to State regulation.
(3) (i) "Member" means an individual entitled to health care
benefits under a policy or plan issued or delivered in the State by a carrier.
(ii) "Member" includes a subscriber.
(4) "nonphysician specialist" means a health care
provider who:
(i) is not a physician;
(ii) is licensed or certified under the health
Occupations Article; and
(iii) is certified or trained to treat or provide
health care services for a specified condition or disease in a
manner that is within the scope of the license or certification of
the health care provider.
[(4)] (5) "Provider panel" has the meaning stated in § 15-112(a) of
this title.
[(5)] (6) "Specialist" means a physician who is certified or trained to
practice in a specified field of medicine and who is not designated as a primary care
provider by the carrier.
(b) (1) Each carrier that does not allow direct access to specialists shall
establish and implement a procedure by which a member may receive a standing
referral to a specialist in accordance with this subsection.
(2) The procedure shall provide for a standing referral to a specialist
if:
(i) the primary care physician of the member determines, in
consultation with the specialist, that the member needs continuing care from the
specialist;
(ii) the member has a condition or disease that:
1. is life threatening, degenerative, chronic, or disabling;
and
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