COMAR 31.10.44.07. Provider-to-Enrollee Ratio Standards

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.

Cross References 31.10.44.04C(13) 31.10.44.09A 31.10.44.09B 31.10.44.11A(3)(b)