1. 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.

2. 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) 1,200 enrollees for primary care;
   2. (2) 2,000 enrollees for pediatric care;
   3. (3) 2,000 enrollees for obstetrical/gynecological care;
   4. (4) 2,000 enrollees for mental health care or services; and
   5. (5) 2,000 enrollees for substance use disorder care or services.

3. C. The ratios described in §B of this regulation shall be calculated based on:

   1. (1) The number of enrollees covered under all health benefit plans issued by the carrier in Maryland that use that provider panel; and

   2. (2) The number of providers in that provider panel with practicing locations:

      1. (a) In Maryland; or
      2. (b) Within the applicable maximum travel distance standard specified in Regulation .05 of this chapter outside the geographic boundaries of Maryland.

Authority: Insurance Article, §§2-109(a)(1) and 15-112(a)—(d), Annotated Code of Maryland

Effective date: December 31, 2017 (44:25 Md. R. 1180)

Chapter revised effective May 15, 2023 (50:9 Md. R. 379)