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<section article="gin" article_name="Insurance" number="15-143" title_number="15" title_name="Health Insurance" subtitle_number="1" subtitle_name="General Provisions">
  <level label="a">
    <text>In this section, “participation agreement” means a contract that:</text>
    <level label="1">
      <text>is executed by a payor or program administrator and other participating entities; and</text>
    </level>
    <level label="2">
      <text>describes the requirements for participation in a payment model subject to this section.</text>
    </level>
  </level>
  <level label="b">
    <text>This section applies only to a payment model described in § 1–302(d)(12) of the Health Occupations Article:</text>
    <level label="1">
      <text>that applies to individuals covered under health insurance; and</text>
    </level>
    <level label="2">
      <text>under which there is cash compensation.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <text>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.</text>
    </level>
    <level label="2">
      <text>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.</text>
    </level>
  </level>
  <level label="d">
    <text>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:</text>
    <level label="1">
      <text>is insurance business; and</text>
    </level>
    <level label="2">
      <text>violates this article or a regulation adopted under this article.</text>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>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.</text>
    </level>
    <level label="2">
      <level label="i">
        <text>The Commissioner shall hold a hearing before issuing an order under paragraph (1) of this subsection.</text>
      </level>
      <level label="ii">
        <text>The Commissioner shall give written notice of the hearing to the filer at least 10 days before the hearing.</text>
      </level>
      <level label="iii">
        <text>The notice shall specify the matters to be considered at the hearing.</text>
      </level>
    </level>
    <level label="3">
      <text>If the compensation arrangement between a health care practitioner and a health care entity changes during its term:</text>
      <level label="i">
        <text>the filer shall submit a revised filing to the Commissioner for review of the changes; and</text>
      </level>
      <level label="ii">
        <text>the Commissioner shall make a new determination, as provided under subsection (d) of this section.</text>
      </level>
    </level>
  </level>
  <level label="f">
    <text>A filing under subsection (c) of this section is subject to the fee required under § 2–112(a)(13) of this article.</text>
  </level>
</section>
