Title 19. Health Care Facilities — Subtitle 7A. Provider-Sponsored Organizations
Statutes in effect as of October 1, 2026.
Md. Code Ann., Health-Gen. § 19-7A-01 (2026)
Title 19. Health Care Facilities
Subtitle 7A. Provider-Sponsored Organizations
§ 19–7A-01LinkCopy Citation
(a)
In this subtitle the following words have the meanings indicated.
(b)
“Commissioner” means the Maryland Insurance Commissioner.
(c)
“Health care services” means a health or medical care procedure or service rendered by a health care provider that:
(1)
Provides testing, diagnosis, or treatment of a human disease or dysfunction; or
(2)
Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction.
(d)
“License” includes a certificate of authority, as defined in § 1-101 of the Insurance Article.
(e)
“Provider” means any person, including a physician or hospital, that is licensed or otherwise authorized in this State to provide health care services.
(f)
“Provider-sponsored organization” means an entity that:
(1)
Is a legal aggregation of providers operating collectively for the purpose of providing health care services to Medicare beneficiaries under the federal Medicare+Choice Program;
(2)
Acts through a licensed entity, such as a partnership, corporation, limited liability company, limited liability partnership, or sole proprietorship, that has authority over the entity’s activities and responsibility for satisfying the requirements of § 19-7A-02 of this subtitle; and
(3)
Provides a substantial proportion of the health care services required to be provided under the federal Medicare+Choice Program directly through providers or affiliated groups of providers.
Md. Code Ann., Health-Gen. § 19-7A-02 (2026)
Title 19. Health Care Facilities
Subtitle 7A. Provider-Sponsored Organizations
§ 19–7A-02LinkCopy Citation
(a)
A license issued to a provider-sponsored organization under this subtitle authorizes the licensee to provide health care services only to Medicare beneficiaries under the federal Medicare+Choice Program.
(b)
Nothing in this subtitle may be construed to limit a provider-sponsored organization from participating in the Medicaid program as a managed care organization.
Md. Code Ann., Health-Gen. § 19-7A-03 (2026)
Title 19. Health Care Facilities
Subtitle 7A. Provider-Sponsored Organizations
§ 19–7A-03LinkCopy Citation
(a)
(1)
Before an entity may operate as a provider-sponsored organization under the federal Medicare+Choice Program, the entity must obtain a license from the Commissioner.
(2)
The Commissioner shall issue a license under paragraph (1) of this subsection to any entity to operate as a provider-sponsored organization that meets the requirements of subsection (b) of this section.
(b)
To operate as a provider-sponsored organization under the federal Medicare+Choice Program in this State, an entity shall:
(1)
Meet the definition of a provider-sponsored organization under § 19-7A-01 of this subtitle; and
(2)
Meet the requirements applicable to a health maintenance organization under Subtitle 7 of this title to the extent those requirements are not preempted by federal law.
Md. Code Ann., Health-Gen. § 19-7A-04 (2026)
Title 19. Health Care Facilities
Subtitle 7A. Provider-Sponsored Organizations
§ 19–7A-04LinkCopy Citation
(a)
The Commissioner shall adopt regulations to implement the provisions of this subtitle.
(b)
Except as provided in subsection (c) of this section, regulations relating to the solvency of a provider-sponsored organization adopted under subsection (a) of this section shall impose solvency requirements the same as required under federal law.
(c)
Upon the expiration, repeal, or termination of solvency requirements under federal law for provider-sponsored organizations, the requirements of § 19-710(d) of this title shall apply.