In this subtitle the following words have the meanings indicated. “Administrator” means a carrier administering a self–funded group health plan. “Carrier” has the meaning stated in § 15–113 of this title. “Health benefit plan” has the meaning stated in § 2–112.2 of this article. “Health care practitioner” has the meaning stated in § 15–113 of this title. “Member” has the meaning stated in § 15–10A–01 of this title. “Network” has the meaning stated in § 15–112 of this title. “Participant” means an employee or an employee’s dependent who participates in a self–funded group health insurance plan. “Set of health care practitioners” has the meaning stated in § 15–113 of this title.

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: calculated as a fixed amount per member or participant assigned or attributed to the health care practitioner or set of health care practitioners; 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 paid periodically regardless of utilization of the services by the members or participants. 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. 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: the health care practitioner or set of health care practitioners participates in the administrator’s network and accepts capitated payments; the self–funded group health plan retains the obligation to provide access to covered health care benefits to participants; and the contract does not include other reimbursement arrangements that are considered acts of an insurance business under § 4–205(c) of this article. Notwithstanding subsections (b) and (c) of this section, nothing in this section may be construed to: 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 supersede the Health Services Cost Review Commission’s jurisdiction or authority over rate review and approval for hospital services.