<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 31.10.44.07" title_num="31" subtitle_num="10" chapter_num="44" heading="Provider-to-Enrollee Ratio Standards.">
  <paragraph num="A.">
    <text>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.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The provider-to-enrollee ratios shall be equivalent to at least 1 full-time physician, or as appropriate, another full-time provider for:</text>
    <paragraph num="(1)">
      <text>1,200 enrollees for primary care;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>2,000 enrollees for pediatric care;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>2,000 enrollees for obstetrical/gynecological care;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>2,000 enrollees for mental health care or services; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>2,000 enrollees for substance use disorder care or services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The ratios described in §B of this regulation shall be calculated based on:</text>
    <paragraph num="(1)">
      <text>The number of enrollees covered under all health benefit plans issued by the carrier in Maryland that use that provider panel; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The number of providers in that provider panel with practicing locations:</text>
      <paragraph num="(a)">
        <text>In Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Within the applicable maximum travel distance standard specified in Regulation .05 of this chapter outside the geographic boundaries of Maryland.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>