Determining when a provider compensation arrangement constitutes the business of insurance
(a) In this section, “participation agreement” means a contract that:
(1) is executed by a payor or program administrator and other participating entities; and
(2) describes the requirements for participation in a payment model subject to this section.
(b) This section applies only to a payment model described in § 1-302(d)(12) of the Health Occupations Article:
(1) that applies to individuals covered under health insurance; and
(2) under which there is cash compensation.
(c)(1) Except as provided in paragraph (2) of this subsection, at least 60 days before an exemption provided under § 1-302(d)(12) of the Health Occupations Article for a payment model subject to this section is implemented, the participation agreement and other documents relevant to the payment model under which a compensation arrangement between a health care practitioner and a health care entity is funded or paid shall be filed with the Commissioner.
(2) The filing under paragraph (1) of this subsection is not required if the compensation arrangement is funded fully by or paid fully under the Medicare or Medicaid program.
(d) Within 60 days after the documents required under subsection (c)(1) of this section are filed, the Commissioner shall determine if any compensation arrangement between a health care practitioner and a health care entity funded by or paid under the payment model:
(1) is insurance business; and
(2) violates this article or a regulation adopted under this article.
(e)(1) If the Commissioner determines that a compensation arrangement is insurance business and violates this article or a regulation adopted under this article, the Commissioner shall issue an order to the filer that specifies the ways in which the compensation arrangement violates this article or a regulation adopted under this article.
(2)(i) The Commissioner shall hold a hearing before issuing an order under paragraph (1) of this subsection.
(ii) The Commissioner shall give written notice of the hearing to the filer at least 10 days before the hearing.
(iii) The notice shall specify the matters to be considered at the hearing.
(3) If the compensation arrangement between a health care practitioner and a health care entity changes during its term:
(i) the filer shall submit a revised filing to the Commissioner for review of the changes; and
(ii) the Commissioner shall make a new determination, as provided under subsection (d) of this section.
(f) A filing under subsection (c) of this section is subject to the fee required under § 2-112(a)(13) of this article.