(a) In this title the following words have the meanings indicated. (a–1) “Dental managed care organization” means a pre–paid dental plan that receives fees to manage dental services. (a–2) “Dental services” means diagnostic, emergency, preventive, and therapeutic services for oral diseases. (b) “Enrollee” means a program recipient who is enrolled in a managed care organization. (b–1) “Expedited eligibility” means a […]
(a) Except as otherwise provided in this subtitle, a managed care organization is not subject to the insurance laws of the State or to the provisions of Title 19 of this article. (b) A managed care organization may not be required to offer a qualified plan, as defined in § 31–101 of the Insurance Article, in the […]
(a) Subject to the limitations of the State budget, the Department shall provide preventive and home care services for indigent and medically indigent individuals. (b) (1) The Program shall promote educational opportunities for recipients on: (i) Preventive health care; (ii) Good health habits; and (iii) The value of developing ongoing relationships with primary care and lower cost providers. (2) In educating Program […]
(a) The General Assembly finds that it is a goal of this State to promote the development of a health care system that provides adequate and appropriate health care services to indigent and medically indigent individuals. (b) The Department shall, to the extent permitted, subject to the limitations of the State budget: (1) Provide a comprehensive system of […]
(a) Except as otherwise provided in this section, the provisions of § 19-706.1 of this article (Rehabilitation and liquidation) shall apply to managed care organizations in the same manner they apply to health maintenance organizations. (b) (1) A health care provider may not assert a claim of subrogation against an enrollee of a managed care organization or the […]
(a) The provisions of § 15–112(b)(1)(ii) and (2), (f) through (m), (r), (s), and (u) through (w) of the Insurance Article (Provider panels) shall apply to managed care organizations in the same manner they apply to carriers. (b) The provisions of § 15–1005 of the Insurance Article shall apply to managed care organizations in the same manner […]
(a) (1) Each managed care organization shall be actuarially sound. (2) (i) Except as otherwise provided in this section, the surplus that a managed care organization is required to have shall be paid in full. (ii) A managed care organization shall have an initial surplus that exceeds the liabilities of the managed care organization by at least $1,500,000. (b) (1) In consultation […]
(a) Subject to § 15-103(f) of this subtitle, a health maintenance organization that requires its panel providers to participate in a managed care organization shall establish a mechanism, subject to review by the Secretary, which provides for equitable distribution of enrollees and which ensures that a provider will not be assigned a disproportionate number of enrollees. […]
(a) (1) Subject to paragraph (2) of this subsection, the provisions of Title 7 of the Insurance Article apply to managed care organizations. (2) Before approving a transaction under § 7–306 of the Insurance Article, the Insurance Commissioner shall consult with the Secretary. (3) The Insurance Commissioner: (i) Shall adopt regulations establishing a reporting materiality threshold; and (ii) May adopt regulations […]
The premium tax imposed under § 6-102 of the Insurance Article applies to managed care organizations.
(a) The Department may impose a claims processing charge on all Medicaid claims processed, approved, and paid by the Department to hospitals located in the District of Columbia for the provision of inpatient and outpatient hospital services. (b) The amount to be paid under subsection (a) of this section may not exceed 6% of the amount of […]
(a) (1) The Secretary shall administer the Maryland Medical Assistance Program. (2) The Program: (i) Subject to the limitations of the State budget, shall provide medical and other health care services for indigent individuals or medically indigent individuals or both; (ii) Shall provide, subject to the limitations of the State budget, comprehensive medical, dental, and other health care services for […]
The Program shall use its leverage as a high volume purchaser to promote the cost effectiveness of Maryland’s health care system.
(a) The Department shall issue a request for proposals for the administration of dental services for Program recipients for the purpose of comparing and evaluating the performance and cost of dental services provided by a managed care organization and the performance and cost of dental services provided by a dental managed care organization that is separate […]
(a) There is a HealthChoice Performance Incentive Fund established in the Department. (b) (1) The Department shall pay all fines collected under § 15–103(b)(12)(v) of this subtitle and penalties collected under § 15–103.7(e)(2)(iv) of this subtitle to the Comptroller of the State. (2) The Comptroller shall distribute the fines to the Fund. (c) (1) The Fund shall be used exclusively for […]
(a) A managed care organization may deem a health care provider credentialed for a period of not more than 6 months from the date of receipt of a completed application if: (1) The health care provider: (i) Has been credentialed by another entity in the State that is required to credential health care providers; and (ii) Has submitted an […]
(a) For the calendar year prior to the report date under subsection (b) of this section, the Department shall review the rates paid to providers under the federal Medicare fee schedule and compare the rates under the Medicare fee schedule to the fee–for–service rates paid to similar providers for the same services under the Maryland Medical […]
(a) (1) Subject to paragraph (2) of this subsection, on or before June 30, 2017, the Department shall adopt regulations necessary to ensure that the Program is in compliance with the federal Mental Health Parity and Addiction Equity Act and the federal Patient Protection and Affordable Care Act. (2) The Department is not required to adopt regulations under […]
(a) In this section, “Program” means the program established by the Department under subsection (b) of this section. (b) (1) The Department shall establish a value–based purchasing program that awards financial incentives to and assesses penalties on managed care organizations based on the organization’s performance on health measures established by the Department. (2) The Department shall, in accordance with […]
The Secretary may contract with the Department of Human Services to provide medical services to those individuals for whom: (1) Funds are appropriated to the Department of Human Services; and (2) The Department of Human Services is responsible under the appropriation.
