Section 15-2101. Definitions
(a) In this subtitle the following words have the meanings indicated.
(b) “Administrator” means a carrier administering a self–funded group health plan.
(c) “Carrier” has the meaning stated in § 15–113 of this title.
(d) “Health benefit plan” has the meaning stated in § 2–112.2 of this article.
(e) “Health care practitioner” has the meaning stated in § 15–113 of this title.
(f) “Member” has the meaning stated in § 15–10A–01 of this title.
(g) “Network” has the meaning stated in § 15–112 of this title.
(h) “Participant” means an employee or an employee’s dependent who participates in a self–funded group health insurance plan.
(i) “Set of health care practitioners” has the meaning stated in § 15–113 of this title.
See https://mgaleg.maryland.gov/mgawebsite/laws/StatuteText?article=gin§ion=15-2101&enactments=false
Section 15-2102. Requirements on capitated arrangements
(a) This section applies to arrangements under a health benefit plan offered by a carrier or a self–funded group health insurance plan in which a capitated payment is:
(1) calculated as a fixed amount per member or participant assigned or attributed to the health care practitioner or set of health care practitioners;
(2) to cover the provision of a set of services defined in the health care practitioner’s or set of health care practitioners’ contract and rendered by the health care practitioner or set of health care practitioners; and
(3) paid periodically regardless of utilization of the services by the members or participants.
(b) Subject to the requirements of subsection (c) of this section, a health care practitioner or set of health care practitioners is not engaged in insurance business as described in § 4–205 of this article solely because the health care practitioner or set of health care practitioners enters into a contract with a carrier that includes capitated payments for services provided by the health care practitioner or set of health care practitioners.
(c) A health care practitioner or set of health care practitioners is not engaged in insurance business as described in § 4–205(c) of this article solely because the health care practitioner or set of health care practitioners enters into a contract with an administrator that includes capitated payments for services provided by the health care practitioner or set of health care practitioners to members of a self–funded group health plan if:
(1) the health care practitioner or set of health care practitioners participates in the administrator’s network and accepts capitated payments;
(2) the self–funded group health plan retains the obligation to provide access to covered health care benefits to participants; and
(3) the contract does not include other reimbursement arrangements that are considered acts of an insurance business under § 4–205(c) of this article.
(d) Notwithstanding subsections (b) and (c) of this section, nothing in this section may be construed to:
(1) alter any requirement for a carrier or self–funded group health plan to pay a hospital or related institution the rate approved by the Health Services Cost Review Commission for hospital services; or
(2) supersede the Health Services Cost Review Commission’s jurisdiction or authority over rate review and approval for hospital services.