<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 31.10.34.05" title_num="31" subtitle_num="10" chapter_num="34" heading="Availability Plan.">
  <paragraph num="A.">
    <text>A carrier shall implement an availability plan describing:</text>
    <paragraph num="(1)">
      <text>If the carrier is an insurer or nonprofit health service plan, the quantifiable and measurable standards for the number and geographic distribution of:</text>
      <paragraph num="(a)">
        <text>General and internal medicine providers;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Family practitioners;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Pediatricians;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Obstetricians and gynecologists;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>High-volume specialty behavioral health care providers, including psychiatrists, psychologists, clinical social workers, and any other behavioral health care providers identified by the carrier; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>High-volume specialty health care providers, identified by the carrier; or</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If the carrier is a dental plan organization, or an insurer or nonprofit health service plan that provides coverage only for dental services, the quantifiable and measurable standards for the number and geographic distribution of:</text>
      <paragraph num="(a)">
        <text>Dentists; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Any other dental service provider identified by the carrier.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The availability plan required by §A of this regulation shall also include:</text>
    <paragraph num="(1)">
      <text>The method used to annually assess the carrier's performance against the standards specified in the availability plan;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The method used to ensure timely access to health care services, as identified by the carrier; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The carrier's process for monitoring and assuring on an ongoing basis the sufficiency of the provider panel to meet the health care needs of enrollees.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Availability Plan and Annual Performance Assessment.</text>
    <paragraph num="(1)">
      <text>A carrier shall:</text>
      <paragraph num="(a)">
        <text>On an annual basis, review and update the availability plan required by §A of this regulation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>On an annual basis, conduct a performance assessment regarding its compliance with its availability plan using the method provided in §B(1) of this regulation; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Submit its availability plan and its annual performance assessment to the Commissioner upon request.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>In addition to the requirements of §C(1) of this regulation, a prominent carrier shall submit to the Commissioner the prominent carrier's:</text>
      <paragraph num="(a)">
        <text>Availability plan not later than:</text>
        <paragraph num="(i)">
          <text>90 days after the effective date of this chapter, if the carrier is a prominent carrier on the effective date of this chapter; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>90 days after the carrier becomes a prominent carrier, if the carrier becomes a prominent carrier after the effective date of this chapter; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Annual performance assessment:</text>
        <paragraph num="(i)">
          <text>Not later than November 1, 2008, for the period beginning on the effective date of this regulation; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Within 30 days of completing the annual performance assessment, for calendar year 2009 and thereafter.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>In addition to the requirements of §C(2) of this regulation, a prominent carrier shall:</text>
      <paragraph num="(a)">
        <text>File with the Commissioner the availability plan described in §C(2)(a) of this regulation not later than 30 days after the carrier makes any change to the availability plan;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provide annually to the Commissioner a list of the hospital-based physician specialties available on the prominent carrier's provider panel; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Submit the report required in §A of this regulation with the submission of the prominent carrier's performance assessment required by §C(2)(b) of this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>The Commissioner may request additional information from the carrier in order to evaluate the carrier's performance with the availability plan.</text>
    </paragraph>
  </paragraph>
</regulation>