<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05-1" citation="COMAR 10.67.05.05-1" title_num="10" subtitle_num="67" chapter_num="05" heading="Access Standards: Specialty Provider Network.">
  <paragraph num="A.">
    <text>Standards and Regions.</text>
    <paragraph num="(1)">
      <text>The Department shall review an MCOs specialty provider network for MCOs overall network as defined in this regulation.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Overall Network Standards.</text>
      <paragraph num="(a)">
        <text>An MCO shall meet either the time or distance standard set forth in Regulation .06A of this chapter for core, major, and pediatric specialties.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The nine core specialties are:</text>
        <paragraph num="(i)">
          <text>Cardiology;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Otolaryngology (ENT);</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Gastroenterology;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Neurology;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Oncology;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Ophthalmology;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Orthopedics;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Surgery; and</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>Urology.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>The 6 major specialties are:</text>
        <paragraph num="(i)">
          <text>Allergy and immunology;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Dermatology;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Endocrinology;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Infectious disease;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Nephrology; and</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Pulmonology.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>The 4 pediatric subspecialties are:</text>
        <paragraph num="(i)">
          <text>Cardiology;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Gastroenterology;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Neurology; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Surgery.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>If the Department determines that an MCO does not meet the requirements specified in §A(2)(b)(d) of this regulation, the MCO may provide additional information to support the adequacy of the MCO's specialty network before any action is taken by the Department.</text>
  </paragraph>
  <paragraph num="C.">
    <text>If an MCO fails to meet the requirements established by this regulation, the Department may suspend the automatic assignment to the MCO of recipients who live in the affected local access area.</text>
  </paragraph>
</regulation>