Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.44 - Network Adequacy
Section 31.10.44.07 - Provider-to-Enrollee Ratio Standards
Universal Citation: MD Code Reg 31.10.44.07
Current through Register Vol. 51, No. 19, September 20, 2024
A. Except for a Group Model HMO's health benefit plan, the provider panel for each carrier shall meet the provider-to-enrollee ratio standards listed in §B of this regulation.
B. The provider-to-enrollee ratios shall be equivalent to at least 1 full-time physician, or as appropriate, another full-time provider for:
(1) 1,200 enrollees for primary care;
(2) 2,000 enrollees for pediatric care;
(3) 2,000 enrollees for obstetrical/gynecological care;
(4) 2,000 enrollees for mental health care or services; and
(5) 2,000 enrollees for substance use disorder care or services.
C. The ratios described in §B of this regulation shall be calculated based on:
(1) The number of enrollees covered under all health benefit plans issued by the carrier in Maryland that use that provider panel; and
(2) The number of providers in that provider panel with practicing locations:
(a) In Maryland; or
(b) Within the applicable maximum travel distance standard specified in Regulation .05 of this chapter outside the geographic boundaries of Maryland.
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