Md. Code Regs. 31.10.45.05

Current through Register Vol. 51, No. 24, December 2, 2024

Section 31.10.45.05 - Waiver Request Standards

A. A carrier may apply for a dental network adequacy waiver, for up to 1 year, of a dental network adequacy requirement listed in this chapter.

B. The Commissioner may find good cause to grant the dental network adequacy waiver request only if the carrier demonstrates that the providers necessary for an adequate network:

(1) Are not available to contract with the carrier;

(2) Are not available in sufficient numbers;

(3) Have refused to contract with the carrier; or

(4) Are unable to reach agreement with the carrier.

C. A carrier seeking a dental network adequacy waiver shall submit a written request to the Commissioner that includes the following information:

(1) A description of any waiver previously granted by the Commissioner;

(2) A list of providers within the relevant service area that the carrier attempted to contract with, identified by name and specialty, if any, or facility type;

(3) A description of how and when the carrier last contacted the providers;

(4) A description of any reason each provider gave for refusing to contract with the carrier;

(5) Steps the carrier will take to attempt to improve its network to avoid future dental network adequacy waiver requests;

(6) If applicable, a statement that there are no providers available within the relevant service area for a covered service or services for which the carrier requests the waiver; and

(7) An attestation to the accuracy of the information contained in the dental network adequacy waiver request.

D. A carrier submitting a dental network adequacy waiver request may submit a written request to the Commissioner that specific information included in the plan or request not be disclosed under the Public Information Act and shall:

(1) Identify the particular information that the carrier requests not be disclosed; and

(2) Cite the statutory authority that permits denial of access to the information.

E. The Commissioner may review a request made under §D of this regulation upon receipt of a request for access pursuant to the Public Information Act.

F. The Commissioner may notify the carrier that made a request under §D of this regulation before granting access to information that was the subject of the request.

Md. Code Regs. 31.10.45.05

Regulation .05 adopted effective 44:25 Md. R. 1184, eff. 12/31/2017