Sec. 10.67.05.05-1. Access Standards: Specialty Provider Network

A. Standards and Regions.

(1) The Department shall review an MCO’s specialty provider network for MCO’s overall network as defined in this regulation.

(2) Overall Network Standards.

(a) An MCO shall meet either the time or distance standard set forth in Regulation .06A of this chapter for core, major, and pediatric specialties.

(b) The 8 core specialties are:

(i) Cardiology;

(ii) Otolaryngology (ENT);

(iii) Gastroenterology;

(iv) Neurology;

(v) Ophthalmology;

(vi) Orthopedics;

(vii) Surgery; and

(viii) Urology.

(c) The 6 major specialties are:

(i) Allergy and immunology;

(ii) Dermatology;

(iii) Endocrinology;

(iv) Infectious disease;

(v) Nephrology; and

(vi) Pulmonology.

(d) The 4 pediatric subspecialties are:

(i) Cardiology;

(ii) Gastroenterology;

(iii) Neurology; and

(iv) Surgery.

B. If the Department determines that an MCO does not meet the requirements specified in §A(2)(b)-(d) of this regulation, the MCO may provide additional information to support the adequacy of the MCO's specialty network before any action is taken by the Department.

C. If an MCO fails to meet the requirements established by this regulation, the Department may suspend the automatic assignment to the MCO of recipients who live in the affected local access area. A suspension of automatic assignments may affect the MCO's ability to qualify for the Statewide supplemental payments specified under COMAR 10.67.04.19-3.