§ 15–1703
Statutes in effect as of October 1, 2026.
Md. Code Ann., Ins. § 15-1703 (2026)
Title 15. Health Insurance
Subtitle 17. Regulation of Physician Rating Systems
§ 15–1703LinkCopy Citation
(a)
A carrier that uses a physician rating system shall:
(1)
establish an appeals process for physicians to use to contest their rating; and
(2)
at least 45 days before making available to enrollees any new or revised quality of performance or cost–efficiency evaluations or any new or revised inclusions or exclusions from a physician rating system, provide each physician included in the physician rating system with:
(i)
a notice of the proposed change;
(ii)
an explanation of the data used to assess the physician and how the physician may access the data;
(iii)
the methodology and measures used to assess the physician;
(iv)
an explanation of the right to contest the rating of the physician through the appeals process of the carrier; and
(v)
instructions on how to file a timely appeal with the carrier.
(b)
If a physician files a timely appeal, as defined by the carrier, regarding the rating of the physician under a physician rating system, the carrier may not disclose the rating of the physician or make a change in the quality of performance or cost–efficiency ratings of the physician until the carrier completes its investigation and renders a decision on the appeal.
(c)
A carrier shall post the following information prominently on the section of the carrier’s Web site that discloses the rating of a physician to enrollees or to the public:
(1)
where an enrollee can find the physician performance ratings of the carrier;
(2)
a disclosure that physician performance ratings are only a guide to choosing a physician because the ratings have a risk of error and should not be the sole basis for selecting a physician;
(3)
an explanation of the physician rating system, including the basis on which physician performance is measured and the basis for determining that a physician is not currently rated due to insufficient data or a pending appeal;
(4)
any limitations of the data that the carrier uses to measure physician performance;
(5)
the factors and criteria used in the carrier’s physician rating system, including quality of performance measures and cost efficiency measures; and
(6)
how a physician may appeal a physician rating.