§ 15-601. Benefits for using low-cost hospitals

MD Ins Code § 15-601 (2019) (N/A)

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(a) This section applies to insurers and nonprofit health service plans that provide hospital benefits in the State under individual, group, or blanket health insurance policies.

(b) Each entity subject to this section that offers benefits to an insured or beneficiary who uses designated low-cost hospitals, that are different from the benefits offered when other hospitals are used, shall base its designation of a low-cost hospital on information that:

(1) excludes the reasonable cost of medical education and of uncompensated care as determined by the Health Services Cost Review Commission;

(2) excludes the cost associated with a shock trauma facility as determined by the Health Services Cost Review Commission;

(3) excludes the amount in rates approved by the Health Services Cost Review Commission for undergraduate nursing education;

(4) excludes from consideration each hospital that is determined by the Maryland Health Care Commission to be a sole community provider; and

(5) compares hospitals on a regional basis, unless the entity demonstrates to the satisfaction of the Commissioner that a statewide comparison is more appropriate.

(c) An entity subject to this section that provides hospital benefits under subsection (b) of this section may not subsidize those benefits from premiums earned by other benefit plans, programs, or policies.

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§ 15-602. Treatment in State or local government hospitals or institutions