Health Insurance - Provider Panels - Requirements

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb1093*

HOUSE BILL 1093
J5 6lr2823
CF SB 808
By: Delegate Cullison Delegates Cullison, Alston, Bagnall , Guzzone, Hill,
Hutchinson, S. Johnson, Kaufman, Kipke, Lopez, Martinez, M. Morgan,
Reilly, Rosenberg, Ross, Szeliga, Taveras, White Holland, and Woorman
Introduced and read first time: February 11, 2026
Assigned to: Health
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 6, 2026

CHAPTER ______

AN ACT concerning 1

Health Insurance – Provider Panels – Requirements 2

FOR the purpose of altering the process though through which health care providers apply 3
to participate on a carrier’s provider panel, including for certain notice requirements; 4
establishing certain civil penalties for carriers that fail to provide certain notices in 5
a certain manner and certain time frame; repealing the authorization for a carrier 6
to charge a certain application fee; requiring carriers to use certain information to 7
update the carrier’s provider directory at a certain frequency; altering a requirement 8
for certain carriers to update certain inf ormation on a provider directory within a 9
certain period of time after receipt of certain notices; altering a requirement for 10
carriers to reimburse for certain covered services provided by a nonparticipating 11
provider; expanding the types of providers a carrier is prohibited from limiting on a 12
provider panel; altering the credentialing applications that the Commissioner may 13
designate for a certain credentialing system and the circumstances under which the 14
designation may be made; altering certain requirements for a multi–carrier common 15
online provider directory information system; and generally relating to health 16
insurance provider panels. 17

BY repealing and reenacting, with amendments, 18
Article – Insurance 19
Section 15–112(a), (g), (p), (t), and (w), and (x) 15–112.1, and 15–112.3 20
Annotated Code of Maryland 21
(2017 Replacement Volume and 2025 Supplement) 22
2 HOUSE BILL 1093

BY repealing and reenacting, without amendments, 1
Article – Insurance 2
Section 15–112(n), (o), and (u) and 15–112.1 3
Annotated Code of Maryland 4
(2017 Replacement Volume and 2025 Supplement) 5

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 6
That the Laws of Maryland read as follows: 7

Article – Insurance 8

15–112. 9

(a) (1) In this section the following words have the meanings indicated. 10

(2) “Accredited hospital” has the meaning stated in § 19 –301 of the 11
Health – General Article. 12

(3) “Ambulatory surgical facility” has the meaning stated in § 19–3B–01 of 13
the Health – General Article. 14

(4) “Behavioral health care services” has the meani ng stated in § 15 –127 15
of this subtitle. 16

(5) (i) “Carrier” means: 17

1. an insurer; 18

2. a nonprofit health service plan; 19

3. a health maintenance organization; 20

4. a dental plan organization; or 21

5. any other person that provides health benefit plans 22
subject to regulation by the State. 23

(ii) “Carrier” includes an entity that arranges a provider panel for a 24
carrier. 25

(6) “Credentialing intermediary” means a person to whom a carrier has 26
delegated credentialing or recredentialing authority and responsibility. 27

(7) “Enrollee” means a person entitled to health care benefits from a 28
carrier. 29

HOUSE BILL 1093 3

(8) “Group model health maintenance organization” has the meaning 1
stated in § 19–713.6(a) of the Health – General Article. 2

(9) “Health benefit plan”: 3

(i) for a group or blanket plan in the large group market, has the 4
meaning stated in § 15–1401 of this title; 5

(ii) for a group in the small group market, has the meaning stated in 6
§ 31–101 of this article; and 7

(iii) for an individual pla n, has the meaning stated in § 15 –1301 of 8
this title. 9

(10) (i) “Health care facility” means a health care setting or institution 10
providing physical, mental, or substance use disorder health care services. 11

(ii) “Health care facility” includes: 12

1. a hospital; 13

2. an ambulatory surgical or treatment center; 14

3. a skilled nursing facility; 15

4. a residential treatment center; 16

5. an urgent care center; 17

6. a diagnostic, laboratory, or imaging center; 18

7. a rehabilitation facility; and 19

8. any other therapeutic health care setting. 20

(11) “Hospital” has the meaning stated in § 19–301 of the Health – General 21
Article. 22

(12) “Network” means a carrier’s participating providers and the health care 23
facilities with which a carrier contracts to provide health care services to the carrier’s 24
enrollees under the carrier’s health benefit plan. 25

(13) “Online credentialing system” means the system through which a 26
provider may access AND SUBMIT an online provider credentialing app lication that the 27
Commissioner has designated as the uniform credentialing form under § 15–112.1(e) of this 28
subtitle. 29

4 HOUSE BILL 1093

(14) “Participating provider” means a provider on a carrier’s provider panel. 1

(15) “Provider” means a health care practitioner or gr oup of health care 2
practitioners licensed, certified, or otherwise authorized by law to provide health care 3
services. 4

(16) “Provider directory” means a list of a carrier’s participating providers 5
and participating health care facilities. 6

(17) (i) “Provider panel” means the providers that contract either 7
directly or through a subcontracting entity with a carrier to provide health care services to 8
the carrier’s enrollees under the carrier’s health benefit plan. 9

(ii) “Provider panel” does not include an arrangement in which any 10
provider may participate solely by contracting with the carrier to provide health care 11
services at a discounted fee–for–service rate. 12

(g) (1) A provider that seeks to participate on a provider panel of a carrier shall 13
submit an application to the carrier. 14

(2) (i) Subject to subparagraph (ii) of this paragraph and paragraph (3) 15
of this subsection, the carrier, after reviewing the application, shall accept or reject the 16
provider for participation on the carrier’s provider panel. 17

(ii) A carrier may not reject a provider who provides 18
community–based health services for a program accredited under COMAR 10.63.02 for 19
participation on the carrier’s provider panel because the provider practices within the scope 20
of the provider’s license and is: 21

1. a licensed master social worker, as defined in § 19 –101 of 22
the Health Occupations Article; 23

2. a licensed graduate alcohol and drug counselor, a licensed 24
graduate marriage and family therapist, a licensed graduate professional art therapist, or 25
a licensed graduate professional counselor, as those terms are defined in § 17 –101 of the 26
Health Occupations Article; or 27

3. a registered psychology associate, as defined in § 18 –101 28
of the Health Occupations Article. 29

(iii) [If] IN ACCORDANCE WITH PA RAGRAPH (3) OF THIS 30
SUBSECTION, IF the carrier rejects the provider for participation on the carrier’s provider 31
panel, the carrier shall send to the provider [at the address listed in the application] written 32
notice of the rejection. 33

(3) (i) Subject to paragraph (4) of this subsection, within [30] 5 15 days 34
after the date a carrier receives a completed application, the carrier shall send to the 35
HOUSE BILL 1093 5

provider at the E–MAIL address listed in the application OR, IF AN E–MAIL ADDRESS IS 1
NOT LISTED IN THE APPLIC ATION, THE MAILING ADDRESS LISTED IN THE 2
APPLICATION written notice of: 3

1. the carrier’s intent to continue to process the provider’s 4
application to obtain necessary credentialing information; or 5

2. the carrier’s rejection of the provider for participation on 6
the carrier’s provider panel. 7

(ii) The failure of a carrier to provide the notice required under 8
subparagraph (i) of this paragraph is a violation of this article and the carrier is subject to: 9

1. A CIVIL PENALTY OF $500 PER DAY FOR EACH DAY 10
THE NOTICE WAS NOT S ENT, TO BE COLLECTED BY T HE COMMISSIONER AND PAID 11
TO THE PROVIDER; AND 12

2. the penalties provided by § 4–113(d) of this article. 13

(iii) Except as provided in subsection (v) of this section and 14
subparagraph (iv) of this paragraph, if, under subparagraph (i)1 of this paragraph, a carrier 15
provides notice to the provider of its intent to continue to process the provider’s application 16
to obtain necessary credentialing information, the carrier, within [120] 30 60 days after 17
the date the notice is provided, shall: 18

1. accept or reject the provider for participation on the 19
carrier’s provider panel; and 20

2. send written notice of the acceptance or rejection to the 21
provider at the E–MAIL address listed in the application OR, IF AN E–MAIL ADDRESS IS 22
NOT LISTED IN THE AP PLICATION, THE MAILING ADDRESS LISTED IN THE 23
APPLICATION. 24

(iv) For a provider described in paragraph (2)(ii) of this subsection, 25
if, under subparagraph (i)1 of this para graph, a carrier provides notice to the provider of 26
its intent to continue to process the provider’s application to obtain necessary credentialing 27
information, within [60] 15 30 days after the date a carrier receives a completed 28
application, the carrier shall: 29

1. accept or reject the provider for participation on the 30
carrier’s provider panel; and 31

2. send written notice of the acceptance or rejection to the 32
provider at the E–MAIL address listed in the application OR, IF AN E–MAIL ADDRESS IS 33
6 HOUSE BILL 1093

NOT LIS TED IN THE APPLICATI ON, THE MAILING ADDRESS LISTED IN THE 1
APPLICATION. 2

(v) The failure of a carrier to provide the notice required under 3
subparagraph (iii)2 or (iv) of this paragraph is a violation of this article and the carrier is 4
subject to: 5

1. A CIVIL PENALTY OF $500 PER DAY FOR EACH DAY 6
THE NOTICE WAS NOT S ENT, TO BE COLLECTED BY T HE COMMISSIONER AND PAID 7
TO THE PROVIDER; AND 8

2. the provisions of and penalties provided by §§ 4 –113 and 9
4–114 of this article. 10

(4) (i) [1. Except as provid ed in subsubparagraph 4 of this 11
subparagraph, a ] A carrier that receives a complete application shall [notify] SEND 12
WRITTEN NOTICE TO the provider that the application is complete[. 13

2. If a carrier does not accept applications through the online 14
credentialing system, notice shall be given to the provider] at the E–MAIL address listed in 15
the application OR, IF AN E–MAIL ADDRESS IS NOT LISTED IN THE APPLICATION, THE 16
MAILING ADDRESS LIST ED IN THE APPLICATIO N within 10 days after the date the 17
application is received. 18

[3. If a carrier accepts applications through the online 19
credentialing system, the notice from the online credentialing system to the provider that 20
the carrier has received the provider’s application shall be considered notice that th e 21
application is complete. 22

4. This subparagraph does not apply to a carrier that 23
arranges a dental provider panel until the Commissioner certifies that the online 24
credentialing system is capable of accepting the uniform credentialing form designated b y 25
the Commissioner for dental provider panels.] 26

(ii) 1. (I) A carrier that receives an incomplete application shall 27
return the application to the provider at the E–MAIL address listed in the application OR, 28
IF AN E–MAIL ADDRESS IS NOT LISTED IN THE APPLICATION, THE MAILING ADDRESS 29
LISTED IN THE APPLICATION within 10 days after the date the application is received. 30

2. (II) The carrier shall indicate to the provider what information 31
is needed to make the application complete. 32

3. (III) The provider may return the completed application 33
to the carrier. 34

HOUSE BILL 1093 7

4. (IV) After the carrier receives the completed application, 1
the carrier is subject to the time periods established in paragraph (3) of this subsection. 2

(5) (I) IN THIS PARAGRAPH , “UNIFORM CREDENTIALING FO RM” 3
MEANS THE FORM DESIG NATED BY THE COMMISSIONER UNDER § 15–112.1(E) OF 4
THIS SUBTITLE. 5

(II) A carrier [may charge a reasonable fee for an application 6
submitted to the carrier under this section] SHALL: 7

1. ALLOW A PROVIDER TO SUBMIT THE UNIFORM 8
CREDENTIALING FORM USING THE ONLINE CREDENTIALING SYSTEM; 9

2. ESTABLISH A DIRECT T ELEPHONE NUMBER FOR 10
INQUIRIES ON THE UNI FORM CREDENTIALING F ORM THAT IS MONITORE D BY THE 11
CARRIER AND IS NOT THE GENERAL CUSTOMER SERVICE LINE; 12

3. ESTABLISH A DIRECT E –MAIL ADDRESS FOR 13
INQUIRIES ON THE UNI FORM CREDENTIALING F ORM THAT IS MONITORE D BY THE 14
CARRIER AND IS NOT THE GENERAL CUSTOMER SERVICE E–MAIL ADDRESS; AND 15

4. RESPOND TO VOICE MES SAGES RECEIVED AT TH E 16
TELEPHONE NUMBER EST ABLISHED UNDER ITEM 2 OF THIS SUBPARAGRAPH AND 17
E–MAILS RECEIVED AT THE E–MAIL ADDRESS ESTABLISHED UNDER ITEM 3 OF THIS 18
SUBPARAGRAPH WITHIN 2 BUSINESS DAYS AFTER RECEIPT OF THE VOICE MESSAGE 19
OR E–MAIL. 20

(n) (1) A carrier shall make the carrier’s provider directory av ailable to 21
prospective enrollees on the Internet and, on request of a prospective enrollee, in printed 22
form. 23

(2) The carrier’s provider directory on the Internet shall be available: 24

(i) through a clear link or tab; and 25

(ii) in a searchable format. 26

(3) The provider directory shall include: 27

(i) for each provider on the carrier’s provider panel: 28

1. the name of the provider; 29

2. the specialty areas of the provider; 30

8 HOUSE BILL 1093

3. whether the provider currently is accepting new patients; 1

4. for each office of the provider where the provider 2
participates on the provider panel: 3

A. its location, including its address; and 4

B. contact information for the provider; 5

5. the gender of the provider, if the provider notifies the 6
carrier or the multi –carrier common online provider directory information system 7
designated under § 15–112.3 of this subtitle of the information; and 8

6. any languages spoken by the provider other than English, 9
if the provider notifies the carrier or t he multi–carrier common online provider directory 10
information system designated under § 15–112.3 of this subtitle of the information; 11

(ii) for each health care facility in the carrier’s network: 12

1. the health care facility’s name; 13

2. the health care facility’s address; 14

3. the types of services provided by the health care facility; 15
and 16

4. contact information for the health care facility; and 17

(iii) a statement that advises enrollees and prospective enrollees to 18
contact a provider or a health care facility before seeking treatment or services, to confirm 19
the provider’s or health care facility’s participation in the carrier’s network and the 20
enrollee’s health benefit plan. 21

(o) (1) A carrier shall have a customer service telephone n umber, e –mail 22
address link, or other electronic means by which enrollees and prospective enrollees may 23
notify the carrier of inaccurate information in the carrier’s network directory. 24

(2) If notified of a potential inaccuracy in a network directory by a person 25
other than the provider, a carrier shall investigate the reported inaccuracy and take 26
corrective action, if necessary, to update the network directory within 45 working days after 27
receiving the notification. 28

(p) (1) A carrier shall notify each enrollee at the time of initial enrollment and 29
renewal about how to access or obtain the information required under subsection (n) of this 30
section. 31

HOUSE BILL 1093 9

(2) (i) 1. Information provided in printed form under subsection (n) 1
of this section shall be accurate on the date of publication. 2

2. A carrier shall update the information provided in printed 3
form at least once a year. 4

(ii) 1. Information provided on the Internet under subsection (n) 5
of this section shall be accurate on the date of initial posting and any update. 6

2. In addition to the requirement to update its provider 7
information under subsection (t)(1) of this section, a carrier shall update the information 8
provided on the Internet at least once every 15 days. 9

(3) (I) A CARRIER SHALL USE TH E ONLINE CREDENTIALING 10
SYSTEM AS THE PRIMAR Y SOURCE OF INFORMAT ION TO CREATE AND UP DATE THE 11
CARRIER’S PROVIDER DIRECTORY IN ACCORDANCE WITH R EGULATIONS ADOPTED 12
BY THE COMMISSIONER. 13

(II) THE COMMISSIONER SHALL AD OPT REGULATIONS 14
GOVERNING THE USE BY A CARRIER OF THE ONLINE CR EDENTIALING SYSTEM T O 15
CREATE AND UPDATE TH E CARRIER ’S PROVIDER DIRECTORY , INCLUDING THE 16
REQUIRED FREQUENCY OF UPDATES. 17

[(3)] (4) [A] IN ADDITION TO UPDATE S REQUIRED UNDER 18
PARAGRAPH (3) OF THIS SUBSECTION, A carrier shall: 19

(i) 1. periodically review at least a reasonable sample size of its 20
provider directory for accuracy; and 21

2. retain documentation of the review and make the review 22
available to the Commissioner on request; or 23

(ii) contact providers listed in the carrier’s provider directory who 24
have not submitted a claim in the last 6 months to determine if the providers intend to 25
remain in the carrier’s provider network. 26

[(4)] (5) A carrier shall demonstrate the accuracy of the information 27
provided under paragraph [(3)] (4) of this subsection on request of the Commissioner. 28

[(5)] (6) A carrier shall include in a provider directory that is in printed 29
form a statement notifying a reader that: 30

(i) the information contained in the provider directory is accurate as 31
of the date of publication; and 32

10 HOUSE BILL 1093

(ii) to obtain the most current information, the individual should 1
consult the provider directory on the Internet or contact the carrier directly. 2

[(6)] (7) Before imposing a penalty against a carrier for inaccurate 3
network directory information, the Commissioner shall take into account, in addition to 4
any other factors required by law, whether: 5

(i) the carrier afforded a provider or other person identified in [§ 6
15–112.3(c)] § 15–112.3(D) of this subtitle an opport unity to review and update the 7
provider’s network directory information: 8

1. through the multi –carrier common online provider 9
directory information system designated under § 15–112.3 of this subtitle; or 10

2. directly with the carrier; 11

[(ii) the carrier can demonstrate the efforts made, in writing, 12
electronically, or by telephone, to obtain updated network directory information from a 13
provider or other person identified in § 15–112.3(c) of this subtitle;] 14

[(iii)] (II) the carrier has contacted a provider listed in the carrier’s 15
network directory who has not submitted a claim in the last 6 months to determine if the 16
provider intends to remain on the carrier’s provider panel; 17

[(iv)] (III) the carrier includes in its network directory the las t date 18
that a provider updated the provider’s information; 19

[(v)] (IV) the carrier has implemented any other process or 20
procedure to: 21

1. INFORM PROVIDERS THA T THE ONLINE 22
CREDENTIALING SYSTEM IS THE PRIMARY SOURC E OF INFORMATION TO CREATE 23
AND UPDATE THE CARRIER’S PROVIDER DIRECTORY; 24

[1.] 2. encourage providers to update their network directory 25
information; or 26

[2.] 3. increase the accuracy of its network directory; and 27

[(vi)] (V) a provider or other person identified in [§ 15–112.3(c)] § 28
15–112.3(D) of this subtitle has not updated the provider’s network directory information, 29
despite opportunities to do so. 30

(t) (1) [(i) Subject to subparagraph (ii) of this paragraph, a] A carrier shall 31
update the information that must be made available on the Internet under subsection (n) 32
of this section within 2 working days after receipt of electronic notification or notification 33
HOUSE BILL 1093 11

by first –class mail tracking method from the participating provider of a change in the 1
applicable information. 2

[(ii) A dental carrier shall update the information required by this 3
subsection within 15 working days after receipt of the notification described in 4
subparagraph (i) of this paragraph.] 5

(2) Notification is presumed to have been received by a carrier: 6

(i) 3 working days after the date the participating provider placed 7
the notification in the U.S. mail, if the participating provider maintains the stamped 8
certificate of mailing for the notice; or 9

(ii) on the date recorded by the courier, if the notificatio n was 10
delivered by courier. 11

(u) (1) A carrier may not require a provider that provides health care services 12
through a group practice or health care facility that participates on the carrier’s provider 13
panel under a contract with the carrier to be conside red a participating provider or accept 14
the reimbursement fee schedule applicable under the contract when: 15

(i) providing health care services to enrollees of the carrier through 16
an individual or group practice or health care facility that does not have a contract with the 17
carrier; and 18

(ii) billing for health care services provided to enrollees of the carrier 19
using a different federal tax identification number than that used by the group practice or 20
health care facility under a contract with the carrier. 21

(2) A nonparticipating provider shall notify an enrollee: 22

(i) that the provider does not participate on the provider panel of 23
the enrollee’s carrier; and 24

(ii) of the anticipated total charges for the health care services. 25

(w) (1) Notwithstanding subsection (u)(1) of this section, a carrier shall 26
reimburse a group practice on the carrier’s provider panel at the participating provider rate 27
for covered services provided by a provider who is not a participating provider if: 28

(i) the provider is employed by or a member of the group practice; 29

(ii) the provider has applied for acceptance on the carrier’s provider 30
panel and the carrier has notified the provider of the carrier’s intent to continue to process 31
the provider’s application to obtain necessary credentialing information; 32

12 HOUSE BILL 1093

(iii) the provider has a valid license issued by a health occupations 1
board to practice in the State; and 2

(iv) the provider: 3

1. is currently credentialed by an accredited hospital in the 4
State; [or] 5

2. has professional liability insurance; OR 6

3. HAS IMMUNITY UNDER T HE FEDERAL TORT CLAIMS 7
ACT OR THE MARYLAND TORT CLAIMS ACT. 8

(2) A carrier shall reimburse a group practice on the carrier’s provider 9
panel in accordance with paragraph (1) of this subsection from the date the notice required 10
under subsection (g)(3)(i)1 of this section is sent to the provider until the date the notice 11
required under subsection (g)(3)(iii)2 of this section is sent to the provider. 12

(3) A carrier that sends w ritten notice of rejection of a provider for 13
credentialing under subsection (g)(3)(iii)2 of this section shall reimburse the provider as a 14
nonparticipating provider for covered services provided on or after the date the notice is 15
sent. 16

(4) A health maintenance organization may not deny payment to a provider 17
under this subsection solely because the provider was not a participating provider at the 18
time the services were provided to an enrollee. 19

(5) A provider who is not a participating provider of a car rier and whose 20
group practice is eligible for reimbursement under paragraph (1) of this subsection may not 21
hold an enrollee of the carrier liable for the cost of any covered services provided to the 22
enrollee during the time period described in paragraph (2) of this subsection, except for any 23
deductible, copayment, or coinsurance amount owed by the enrollee to the group practice 24
or provider under the terms of the enrollee’s contract or certificate. 25

(6) A group practice shall disclose in writing to an enrollee at the time 26
services are provided that: 27

(i) the treating provider is not a participating provider; 28

(ii) the treating provider has applied to become a participating 29
provider; 30

(iii) the carrier has not completed its assessment of the qualifications 31
of the treating provider to provide services as a participating provider; and 32

(iv) any covered services received must be reimbursed by the carrier 33
at the participating provider rate. 34
HOUSE BILL 1093 13

(x) A carrier may not impose a limit on the number of [behavioral health 1
providers at a health care facility ] THE FOLLOWING that may be credentialed to 2
participate on a provider panel: 3

(1) BEHAVIORAL HEALTH PROVIDERS AT A HEALTH CARE FACILITY; 4

(2) PROVIDERS AT A FEDERALLY QUALIFIED HEALTH CENTER; 5

(3) PROVIDERS AT A LOCAL HEALTH DEPARTMENT; 6

(4) PROVIDERS AT A SCHOOL–BASED HEALTH CENTER; OR 7

(5) OTHER ESSENTIAL COMMUNITY PROVIDERS. 8

15–112.1. 9

(a) (1) In this section the following words have the meanings indicated. 10

(2) (i) “Carrier” means: 11

1. an insurer; 12

2. a nonprofit health service plan; 13

3. a health maintenance organization; 14

4. a dental plan organization; 15

5. a managed care organization; or 16

6. any other person that provides health benefit plans 17
subject to regulation by the State. 18

(ii) “Carrier” includes an entity that arranges a provider panel for a 19
carrier. 20

(3) “Credentialing intermediary” means a person to whom a carrier has 21
delegated credentialing or recredentialing authority and responsibility. 22

(4) “Health care provider” means an individual who is licensed, certified, 23
or otherwise authorized under the Health Occupations Article to provide health care 24
services. 25

(5) “Provider panel” means the providers that contract with a carrier to 26
provide health care services to the enrollees under a health benefit plan of the carrier. 27
14 HOUSE BILL 1093

(6) “Uniform credentialing form” means the form designated by the 1
Commissioner for use by a carrier or its credentialing intermediary for credentialing and 2
recredentialing a health care provider for participation on a provider panel. 3

(b) (1) Except as provided in subsection (c) of this section, a carrier or its 4
credentialing intermediary shall accept the uniform credentialing form as the sole 5
application for a health care provid er to become credentialed or recredentialed for a 6
provider panel of the carrier. 7

(2) A carrier or its credentialing intermediary shall make the uniform 8
credentialing form available to any health care provider that is to be credentialed or 9
recredentialed by that carrier or credentialing intermediary. 10

(c) The requirements of subsection (b) of this section do not apply to a hospital or 11
academic medical center that: 12

(1) is a participating provider on the carrier’s provider panel; and 13

(2) acts as a credentialing intermediary for that carrier for health care 14
practitioners that: 15

(i) participate on the carrier’s provider panel; and 16

(ii) have privileges at the hospital or academic medical center. 17

(d) The Commissioner may impose a penalty not to exceed $500 against any 18
carrier for each violation of this section by the carrier or its credentialing intermediary. 19

(e) (1) The Commissioner may adopt regulations to implement the provisions 20
of this section. 21

(2) The Commissioner may designate a prov ider credentialing application 22
developed by a nonprofit alliance of health plans and trade associations for an online 23
credentialing system offered to carriers and providers as the uniform credentialing form if: 24

(i) the provider credentialing application is available to providers at 25
no charge; and 26

(ii) use of the provider credentialing application is not conditioned 27
on submitting the provider credentialing application to a carrier through the online 28
credentialing system; 29

(III) THE SYSTEM ALLOWS PROVIDERS TO: 30

1. GRANT ACCESS TO A DESIGNATED PERSON MANAGING 31
THE CREDENTIALING PROCESS FOR THE PROVIDER; AND 32
HOUSE BILL 1093 15

2. ACCESS THE SYSTEM DI RECTLY WITHOUT THE 1
ASSISTANCE OF A THIRD PARTY; AND 2

(IV) THE VENDOR: 3

1. ESTABLISHES AND MAIN TAINS A STAKEHOLDER 4
WORKGROUP TO IDENTIF Y AND ADDRESS OPERAT IONAL ISSUES TO ENSU RE 5
EFFICIENCY OF THE ON LINE CREDENTIALING S YSTEM CONSISTING OF 6
REPRESENTATIVES OF: 7

A. HEALTH AND DENTAL CARRIERS; 8

B. MANAGED CARE ORGANIZATIONS; 9

C. COMMUNITY HEALTH CEN TERS, INCLUDING 10
FEDERALLY QUALIFIED HEALTH CENTERS; 11

D. BEHAVIORAL HEALTH PROVIDERS; 12

E. PRIVATE PRACTICES OF PHYSICIANS, DENTISTS, 13
ADVANCE PRACTICE CLINICIANS, AND OTHER CLINICIANS; AND 14

F. CREDENTIALING INTERMEDIARIES; 15

2. SUBMITS A REPORT TO THE COMMISSIONER BY 16
SEPTEMBER 1 EACH YEAR ON: 17

A. THE FINDINGS OF THE WORKGROUP ESTABLISHE D 18
UNDER ITEM 1 OF THIS ITEM AND IMP ROVEMENTS IMPLEMENTED AS A RESULT OF 19
THE WORKGROUP’S FINDINGS; AND 20

B. FOR EACH CARRIER , THE CALCULATION OF T HE 21
AVERAGE NUMBER OF DAYS BETWE EN THE DATE THE CARR IER RECEIVES A 22
COMPLETED CREDENTIALING APPLICATION AND THE DATE THE CARRIER SENDS 23
WRITTEN NOTICE TO TH E PROVIDER OF THE AC CEPTANCE OR REJECTION OF THE 24
APPLICATION; AND 25

3. MEETS ALL OTHER REQUIREMENTS ESTABLISHED BY 26
THE COMMISSIONER. 27

(3) ON OR BEFORE DECEMBER 1 EACH YEAR , BEGINNING IN 2027, 28
THE COMMISSIONER SHALL REPORT TO THE GENERAL ASSEMBLY, IN ACCORDANCE 29
WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, ON: 30
16 HOUSE BILL 1093

(I) THE FINDINGS OF THE WORKGROUP ESTABLISHED UNDER 1
PARAGRAPH (2)(IV)1 OF THIS SUBSECTION; 2

(II) IMPROVEMENTS IMPLEME NTED AS A RESULT OF THE 3
WORKGROUP’S FINDINGS; 4

(III) ANY LEGISLATIVE RECOMMENDATIONS; AND 5

(IV) ANY OTHER RELEVANT INFORMATION. 6

15–112.3. 7

(a) (1) In this section the following words have the meanings indicated. 8

(2) (i) “Carrier” has the meaning stated in § 15–112 of this subtitle. 9

(ii) “Carrier” does not include a managed care organization, as 10
defined in Title 15, Subtitle 1 of the Health – General Article. 11

(3) “Multi–carrier common online provider directory information system” 12
means the system designated by the Commissioner for use by providers to provide and 13
update their provider directory information with carriers. 14

(b) The Commissioner may designate a multi –carrier common online provider 15
directory information system developed by a nonprofit alliance of health plans and trade 16
associations if: 17

(1) the system is available to providers nationally; 18

(2) the system is available to providers at no charge; 19

(3) the system allows providers to: 20

(i) attest online to the accuracy of their information; [and] 21

(ii) [1. correct any inaccurate information; and 22

2. attest to the correction ] UPDATE THE PROVIDER ’S 23
INFORMATION EVERY 120 DAYS OR AT A FREQUEN CY ESTABLISHED BY TH E 24
COMMISSIONER; 25

(III) GRANT ACCESS TO A DE SIGNATED PERSON MANAGING THE 26
CREDENTIALING PROCESS FOR THE PROVIDER; AND 27

HOUSE BILL 1093 17

(IV) ACCESS THE SYSTEM DIRECTLY WITHOUT THE ASSISTANCE 1
OF A THIRD PARTY; and 2

(4) (2) the nonprofit alliance: VENDOR 3

(I) has a well–established mechanism for outreach to providers; 4

(II) ESTABLISHES AND MAIN TAINS A STAKEHOLDER 5
WORKGROUP TO IDENTIF Y AND ADDRESS OPERAT IONAL ISSUES TO ENSU RE 6
EFFICIENCY OF THE ON LINE CREDENTIALING S YSTEM CONSISTING OF 7
REPRESENTATIVES OF: 8

1. HEALTH AND DENTAL CARRIERS; 9

2. MANAGED CARE ORGANIZATIONS; 10

3. COMMUNITY HEALTH CEN TERS, INCLUDING 11
FEDERALLY QUALIFIED HEALTH CENTERS; 12

4. BEHAVIORAL HEALTH PROVIDERS;. 13

5. PRIVATE PRACTICES OF PHYSICIANS, DENTISTS, 14
ADVANCE PRACTICE CLINICIANS, AND OTHER CLINICIANS; AND 15

6. CREDENTIALING INTERMEDIARIES; 16

(III) SUBMITS A REPORT TO THE COMMISSIONER BY SEPTEMBER 17
1 EACH YEAR ON THE FINDINGS OF THE WORKGROUP ESTABLISHED UNDER ITEM (II) 18
OF THIS ITEM AND IMP ROVEMENTS IMPLEMENTE D AS A RESULT OF THE 19
WORKGROUP’S FINDINGS; AND 20

(IV) MEETS ALL OTHER REQU IREMENTS ESTABLISHED BY THE 21
COMMISSIONER. 22

(C) ON OR BEFORE DECEMBER 1 EACH YEAR , BEGINNING IN 2027, THE 23
COMMISSIONER SHALL RE PORT TO THE GENERAL ASSEMBLY, IN ACCORDANCE 24
WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, ON: 25

(1) THE FINDINGS OF THE WORKGROUP ESTABLISHE D UNDER 26
SUBSECTION (B)(4)(II) OF THIS SECTION; 27

(2) IMPROVEMENTS IMPLEME NTED AS A RESULT O F THE 28
WORKGROUP’S FINDINGS; 29

18 HOUSE BILL 1093

(3) ANY LEGISLATIVE RECOMMENDATIONS; AND 1

(4) ANY OTHER RELEVANT INFORMATION. 2

[(c)] (D) A carrier shall accept new and updated provider directory information 3
for a provider submitted: 4

(1) (i) through the multi –carrier common online provider directory 5
information system; or 6

(ii) directly to the carrier; and 7

(2) from: 8

(i) the provider; 9

(ii) a hospital or academic medical center that: 10

1. is a participating provider on the carrier’s provider panel; 11
and 12

2. acts as a credentialing intermediary for the carrier for 13
providers that: 14

A. participate on the carrier’s provider panel; and 15

B. have privileges at the hospital or academic medical center; 16
or 17

(iii) any other person that performs credentialing functions on behalf 18
of a provider. 19

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 20
October 1, 2026 January 1, 2027. 21

Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.