Regulation .07 Provider-to-Enrollee Ratio Standards.
Regulation .07 Provider-to-Enrollee Ratio Standards.LinkCopy Citation
A.
Except for a Group Model HMOs health benefit plan, the provider panel for each carrier shall meet the provider-to-enrollee ratio standards listed in §B of this regulation.
B.
The provider-to-enrollee ratios shall be equivalent to at least 1 full-time physician, or as appropriate, another full-time provider for:
(1)
1,200 enrollees for primary care;
(2)
2,000 enrollees for pediatric care;
(3)
2,000 enrollees for obstetrical/gynecological care;
(4)
2,000 enrollees for mental health care or services; and
(5)
2,000 enrollees for substance use disorder care or services.
C.
The ratios described in §B of this regulation shall be calculated based on:
(1)
The number of enrollees covered under all health benefit plans issued by the carrier in Maryland that use that provider panel; and
(2)
The number of providers in that provider panel with practicing locations:
(a)
In Maryland; or
(b)
Within the applicable maximum travel distance standard specified in Regulation .05 of this chapter outside the geographic boundaries of Maryland.