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<section article="gin" article_name="Insurance" number="15-1901" title_number="15" title_name="Health Insurance" subtitle_number="19" subtitle_name="Clinically Integrated Organizations">
  <level label="a">
    <text>In this subtitle the following words have the meanings indicated.</text>
  </level>
  <level label="b">
    <text>“Carrier” means:</text>
    <level label="1">
      <text>an insurer;</text>
    </level>
    <level label="2">
      <text>a nonprofit health service plan; or</text>
    </level>
    <level label="3">
      <text>a health maintenance organization.</text>
    </level>
  </level>
  <level label="c">
    <text>“Clinically integrated organization” means:</text>
    <level label="1">
      <text>a joint venture between a hospital and physicians that:</text>
      <level label="i">
        <text>has received an advisory opinion from the Federal Trade Commission or its staff; and</text>
      </level>
      <level label="ii">
        <text>has been established to:</text>
        <level label="1">
          <text>evaluate and improve the practice patterns of the health care providers; and</text>
        </level>
        <level label="2">
          <text>create a high degree of cooperation, collaboration, and mutual interdependence among the health care providers who participate in the joint venture in order to promote the efficient, medically appropriate delivery of covered medical services; or</text>
        </level>
      </level>
    </level>
    <level label="2">
      <text>a joint venture between a hospital and physicians that:</text>
      <level label="i">
        <text>is accountable for total spending and quality; and</text>
      </level>
      <level label="ii">
        <text>the Commissioner determines meets the criteria established by the federal Department of Health and Human Services for an accountable care organization.</text>
      </level>
    </level>
  </level>
  <level label="d">
    <text>“Covered medical services” means the health care services that are included as benefits under a health benefit plan issued by a carrier.</text>
  </level>
  <level label="e">
    <text>“Health benefit plan” has the meaning stated in  § 15–1301 of this title.</text>
  </level>
  <level label="f">
    <text>“Qualifying individual” means an individual covered under a health benefit plan issued by a carrier.</text>
  </level>
</section>
