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31.10.34.00.htm 31.10.34.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 34 Carrier Provider Panels Authority: Insurance Article, §2-108(2) and 15-112(b)1)i)1, Annotated Code of Maryland;
31.10.34.01.htm 31.10.34.01. 01 Purpose.. The purpose of this chapter is to:. A. Establish standards for the creation and maintenance of provider panels by insurers, nonprofit health service plans, and dental plan organizations; andB. Assure the availability of health care providers to meet the health care needs of enrollees..
31.10.34.02.htm 31.10.34.02. 02 Scope.. This chapter applies to insurers, nonprofit health service plans, and dental plan organizations that use provider panels.
31.10.34.03.htm 31.10.34.03. 03 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Accredited hospital" means a hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations.2) "Carrier" means an insurer, a nonprofit health service plan, or a dental plan organization.. 3) "Enrollee" means an individual entitled to health care benefits from a carrier.. 4) "Hospital-based physician" means an anesthesiologist, pathologist, radio
31.10.34.04.htm 31.10.34.04. 04 Provider Panel Sufficiency.. A. A carrier shall maintain a provider panel that is sufficient in numbers and types of available providers to meet the health care needs of enrollees.B. Standards to meet the health care needs of enrollees shall be determined in accordance with the requirements of this chapter, and may be established by reference to any reasonable criteria used by the carrier, including but not limited to:1) Provider-enrollee ratios by specialty;.
31.10.34.05.htm 31.10.34.05. 05 Availability Plan.. A. A carrier shall implement an availability plan describing:. 1) If the carrier is an insurer or nonprofit health service plan, the quantifiable and measurable standards for the number and geographic distribution of:a) General and internal medicine providers;. b) Family practitioners;. c) Pediatricians;. d) Obstetricians and gynecologists;. e) High-volume specialty behavioral health care providers, including psychiatrists, psychologists, c
31.10.34.06.htm 31.10.34.06. 06 Enforcement.. A. In addition to any other enforcement powers available to the Commissioner, if a carrier violates this chapter, the Commissioner may order a carrier to take reasonably appropriate corrective action.B. The reasonably appropriate corrective action required by the Commissioner in §A of this regulation may include, but not be limited to, ordering the carrier to:1) Meet the standards specified in the carrier's availability plan by increasing the number of provi
31.10.34.9999.htm 31.10.34.9999. Administrative History Effective date: July 17, 2008 (35:14 Md. R. 1247).
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