Title 15. Health Insurance — Subtitle 21. Capitated Payments
Statutes in effect as of October 1, 2026.
Md. Code Ann., Ins. § 15-2101 (2026)
Title 15. Health Insurance
Subtitle 21. Capitated Payments
§ 15–2101LinkCopy Citation
(a)
In this subtitle the following words have the meanings indicated.
(b)
“Administrator” means a carrier administering a self–funded group health plan.
(c)
“Carrier” has the meaning stated in § 15–113 of this title.
(d)
“Health benefit plan” has the meaning stated in § 2–112.2 of this article.
(e)
“Health care practitioner” has the meaning stated in § 15–113 of this title.
(f)
“Member” has the meaning stated in § 15–10A–01 of this title.
(g)
“Network” has the meaning stated in § 15–112 of this title.
(h)
“Participant” means an employee or an employee’s dependent who participates in a self–funded group health insurance plan.
(i)
“Set of health care practitioners” has the meaning stated in § 15–113 of this title.
Md. Code Ann., Ins. § 15-2102 (2026)
Title 15. Health Insurance
Subtitle 21. Capitated Payments
§ 15–2102LinkCopy Citation
(a)
This section applies to arrangements under a health benefit plan offered by a carrier or a self–funded group health insurance plan in which a capitated payment is:
(1)
calculated as a fixed amount per member or participant assigned or attributed to the health care practitioner or set of health care practitioners;
(2)
to cover the provision of a set of services defined in the health care practitioner’s or set of health care practitioners’ contract and rendered by the health care practitioner or set of health care practitioners; and
(3)
paid periodically regardless of utilization of the services by the members or participants.
(b)
Subject to the requirements of subsection (c) of this section, a health care practitioner or set of health care practitioners is not engaged in insurance business as described in § 4–205 of this article solely because the health care practitioner or set of health care practitioners enters into a contract with a carrier that includes capitated payments for services provided by the health care practitioner or set of health care practitioners.
(c)
A health care practitioner or set of health care practitioners is not engaged in insurance business as described in § 4–205(c) of this article solely because the health care practitioner or set of health care practitioners enters into a contract with an administrator that includes capitated payments for services provided by the health care practitioner or set of health care practitioners to members of a self–funded group health plan if:
(1)
the health care practitioner or set of health care practitioners participates in the administrator’s network and accepts capitated payments;
(2)
the self–funded group health plan retains the obligation to provide access to covered health care benefits to participants; and
(3)
the contract does not include other reimbursement arrangements that are considered acts of an insurance business under § 4–205(c) of this article.
(d)
Notwithstanding subsections (b) and (c) of this section, nothing in this section may be construed to:
(1)
alter any requirement for a carrier or self–funded group health plan to pay a hospital or related institution the rate approved by the Health Services Cost Review Commission for hospital services; or
(2)
supersede the Health Services Cost Review Commission’s jurisdiction or authority over rate review and approval for hospital services.