1. (a) 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:

   1. (1) calculated as a fixed amount per member or participant assigned or attributed to the health care practitioner or set of health care practitioners;
   2. (2) 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
   3. (3) paid periodically regardless of utilization of the services by the members or participants.
2. (b) 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.

3. (c) 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:

   1. (1) the health care practitioner or set of health care practitioners participates in the administrator's network and accepts capitated payments;
   2. (2) the self-funded group health plan retains the obligation to provide access to covered health care benefits to participants; and
   3. (3) the contract does not include other reimbursement arrangements that are considered acts of an insurance business under § 4-205(c) of this article.

4. (d) Notwithstanding subsections (b) and (c) of this section, nothing in this section may be construed to:

   1. (1) 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
   2. (2) supersede the Health Services Cost Review Commission's jurisdiction or authority over rate review and approval for hospital services.

Added by Acts 2022, c. 297, § 1, eff. Oct. 1, 2022; Acts 2022, c. 298, § 1, eff. Oct. 1, 2022.