Provider Panels - Filing of Availability Plan, Annual Performance Assessment and List of Hospital Based Specialties

BULLETIN 08-24 Date: October 1, 2008 To: Insurers, Nonprofit Health Service Plans and Dental Plan Organizations Re: Provider Panels: Filing of Availability Plan, Annual Performance Assessment and List of Hospital-Based Specialties **************************************************************************** COMAR 31.10.34.05 requires insurers, nonprofit health service plans and dental plan organizations (hereinafter “carriers”) that use provider panels to implement an availability plan and to annually assess performance against the standards included in the availability plan. In addition, prominent carriers are required to submit their availability plan, performance assessment and list of hospital-based physician specialties available on the prominent carrier’s provider panel. The first submission is due November 1, 2008. COMAR 31.10.34.03B (5) defines a prominent carrier as a carrier with at least $90 million in written premium for medical benefits in Maryland in the most recent annual statement. A provider panel is defined as providers that contract either directly with a carrier or through a subcontracting entity with a carrier to provide health care services to the carrier’s enrollees under the carrier’s health benefit plan. All prominent carriers that use provider panels are subject to COMAR 31.10.34. To assist prominent carriers with the submission of a list of hospital-based physician specialties available on their provider panel, the Maryland Insurance Administration (MIA) has developed the table below. The table is available as an Excel spreadsheet on the MIA’s website, www.mdinsurance.state.md.us. The MIA requests that prominent carriers use the Excel spreadsheet and e-mail the completed spreadsheet to mhayes@mdinsurance.state.md.us. Prominent carriers may submit their availability plan and performance electronically to the same e-mail address or by mail to Megan Hayes, Maryland Insurance Administration, 525 St. Paul Place, Baltimore, MD 21202-2272. ______________________________ Beth Sammis Deputy Commissioner Maryland Insurance Administration RALPH S. TYLER Commissioner BETH SAMMIS Deputy Commissioner MARTIN O’MALLEY Governor ANTHONY G. BROWN Lt. Governor 525 St. Paul Place, Baltimore, Maryland 21202-2272 1-800-492-6116 TTY: 1-800-735-2258 www.mdinsurance.state.md.us Hospital-Based Physicians as of July 1, 2008 (Maryland Acute Care Hospitals) Name of insurer, nonprofit health service plan or health maintenance organization NAIC Number In the table below, please indicate the hospital-based physicians contracting with you as of July 1, 2008. Place "1" in the column if the practice for the type of hospital-based physician in the designated hospital has a contract to provide services to your members on a discounted fee for service or other payment arrangement. For example, if the anesthesiology practice/group at Anne Arundel Medical Center had a contract with you on July 1, 2008, you would insert "1" in this column; if not, you would leave the column blank. Anesthesiologist Pathologist Radiologist Neonatologist Emergency Medicine Anne Arundel Medical Center Atlantic General Hospital Baltimore Washington Medical Center Bon Secours Hospital Braddock Hospital (formerly Sacred Heart; part of Western MD Health System) Calvert Memorial Hospital Carroll Hospital Center Chester River Hospital Center Civista Medical Center Doctors Community Hospital Dorchester General Hospital Memorial Hospital at Easton Edward W. McCready Memorial Hospital Fort Washington Medical Center Franklin Square Hospital Center Frederick Memorial Hospital Garrett County Memorial Hospital Good Samaritan Hospital Greater Baltimore Medical Center Harbor Hospital Harford Memorial Hospital Holy Cross Hospital Howard County General Hospital James Lawrence Kernan Hospital Johns Hopkins Bayview Medical Center Johns Hopkins Hospital Laurel Regional Hospital Maryland General Hospital Memorial Hospital and Medical Center of Cumberland Mercy Medical Center Montgomery General Hospital Northwest Hospital Center Peninsula Regional Medical Center Prince George's Hospital Center Shady Grove Adventist Hospital Sinai Hospital of Baltimore Southern Maryland Hospital St. Agnes Hospital St. Josephs Medical Center St. Mary's Hospital Suburban Hospital Union Hospital of Cecil County Union Memorial Hospital University of Maryland Medical Center Upper Chesapeake Medical Center Washington Adventist Hospital Washington County Hospital Total 0 0 0 0 0