Required Filings of Procedures for Specialist Referrals

BULLETIN To: Compliance Officers for Carriers Using Provider Panels Re: Required Filings of Procedures for Specialist Referrals Date: August 4, 1999 Bulletin: Life and Health 99-16 Chapter 120 (House Bill 182) of the Acts of the General Assembly of 1999, enacted provisions which require carriers to file two types of procedures with the Commissioner regarding the rights of covered persons to receive referral services from specialists. The first procedure filing applies if a carrier does not allow direct access to specialists. Section 15-829(b) of House Bill 182 requires the carrier to establish and implement procedures by which a member may receive a standing referral to a specialist who is on the carrier’s provider panel. The second procedure filing applies if a carrier uses a provider panel. In such case, §15-829(c) of House Bill 182 requires the carrier to establish and implement a procedure by which a member may request a referral to a specialist who is not part of the carrier’s provider panel. House Bill 182 becomes effective October 1, 1999. The procedures required by House Bill 182 are required to be implemented by the effective date of the law. The filings of the procedures are required by September 15, 1999. Please return a copy of this bulletin and the required procedure filings to Nancy Muehlberger, Maryland Insurance Administration, 525 St. Paul Place, Baltimore, Maryland 21202 by September 15, 1999. Questions regarding this filing may be directed to Brenda Wilson at (410) 468-2170.
Attached are the two procedure filings required by §15-829 of House Bill 182.
Attached is the procedure filing required by §15-829(c) of House Bill 182. We are not submitting the procedures required by §15-829(b) because our company permits direct access to specialists who are on our provider panel.
We are not submitting the procedures required by §15-829 of House Bill 182 because our company does not use provider panels in Maryland. Company Name _________________________________________________________________ Name of Person Responding to Bulletin ____________________________________________________ Title ____________________________________________________ Telephone # ____________________________________________________ ________________________ Donna B. Imhoff Associate Commissioner