(a) In this subtitle the following words have the meanings indicated. (b) “Benefit package” means a set of health care services to be provided to a member of a health maintenance organization under a contract that entitles the member to the health care services, whether the services are provided: (1) Directly by a health maintenance organization; or (2) Through […]
(a) In adopting this subtitle, the General Assembly intends to: (1) Provide alternative methods for the delivery of health care services to residents of this State, with a view toward achieving greater efficiency and economy in providing these services; (2) Encourage the formation of health maintenance organizations that provide health care services to subscribers or groups of subscribers […]
(a) This subtitle does not: (1) Authorize any person to engage directly or indirectly in the practice of any health occupation except as otherwise authorized by law; (2) Authorize any person to regulate, interfere, or intervene in the relationship between any provider of health care services and the patients of the provider; or (3) Prohibit any health maintenance organization […]
A health maintenance organization may operate as authorized by this subtitle notwithstanding any prohibition against the corporate practice of medicine.
(a) (1) The Secretary may adopt rules, regulations, and standards for the quality of health care services provided by a health maintenance organization through its benefit packages. (2) With the advice of the Department, the Commissioner shall adopt reasonable rules and regulations as necessary to carry out any other provisions of this subtitle. (b) (1) The Commissioner and the Department […]
(a) The Secretary shall adopt regulations that set out reasonable standards of quality of care that a health maintenance organization shall provide to its members. (b) (1) The standards of quality of care shall include: (i) A requirement that a health maintenance organization shall provide for regular hours during which a member may receive services, including providing for services […]
(a) With the advice of the Secretary, the Commissioner shall adopt regulations to establish a system for the receipt and timely investigation of complaints of members and subscribers of health maintenance organizations concerning the operation of any health maintenance organization in this State. (b) The complaint system shall include: (1) A procedure for the timely acknowledgment of receipt […]
(a) In this section, “health maintenance organization” means a health maintenance organization where health care services are delivered by health care providers to subscribers at a central facility or centralized system of facilities operated by the health maintenance organization. (b) The Department shall adopt regulations to require health maintenance organizations to: (1) Adopt, implement, and enforce a policy […]
(a) Any limitation imposed by a health maintenance organization on the receipt of covered services provided to a member or subscriber by a physical therapist licensed under Title 13 of the Health Occupations Article may only be imposed per incident or per injury within a contract period. (b) This subsection may not be construed to prohibit a […]
(a) (1) In this section the following words have the meanings indicated. (2) (i) “Inherited metabolic disease” means a disease caused by an inherited abnormality of body chemistry. (ii) “Inherited metabolic disease” includes a disease for which the State screens newborn babies. (3) (i) “Low protein modified food product” means a food product that is: 1. Specially formulated to have less than 1 […]
(a) If it is necessary to provide emergency services, authorization shall be presumed for utilizing the medical or surgical provider on call for unassigned patients or the appropriate specialist on call for the hospital on that date if: (1) A telephone access system is not operational at the time of the call; or (2) A member’s primary care […]
The 24-hour toll free telephone access system provided by each health maintenance organization shall: (1) Enable members and providers to determine, with one telephone call, the primary care provider assigned to a member; and (2) Enable providers to determine, with one telephone call, the names of three contracted specialist providers for the health maintenance organization who also […]
(a) (1) In this section the following words have the meanings indicated. (2) “HMO Quality Assurance Unit” means the Health Maintenance Organization (HMO) Quality Assurance Unit in the Department. (3) “Quality Assurance Medical Director” means the Medical Director of the HMO Quality Assurance Unit. (b) There is a Health Maintenance Organization (HMO) Quality Assurance Unit in the Department. (c) (1) The Secretary […]
(a) Each health maintenance organization that is issued a certificate of authority by the Commissioner shall be regulated under this subtitle. (b) (1) Any health maintenance organization that is regulated by Title 14, Subtitle 1 of the Insurance Article is subject also to this subtitle. (2) This subsection applies to a corporation described in Title 14, Subtitle 1 of […]
(a) Subject to this section, the provisions of Title 9, Subtitle 2 of the Insurance Article regarding the rehabilitation and liquidation of insurers are applicable to health maintenance organizations. (b) (1) Subject to paragraph (2) of this subsection, any rehabilitation or liquidation of a health maintenance organization shall be deemed to be the rehabilitation or liquidation of an […]
(a) A health maintenance organization shall obtain from the Commissioner a certificate of authority to operate as a health maintenance organization before it may issue any contract or certificate to a member, provide any health care services to a member, or otherwise operate in this State. (b) Except as permitted by the Commissioner and subject to the […]
(a) An applicant for a certificate to operate as a health maintenance organization shall submit an application to the Commissioner on the form that the Commissioner requires. (b) The application shall include or be accompanied by: (1) A copy of the basic health maintenance organizational document and any amendments to it that, where applicable, are certified by the […]
(a) When a health maintenance organization files its initial application for a certificate of authority to operate, it shall pay to the Commissioner a fee of $300. (b) In addition to the fee required under subsection (a) of this section, each health maintenance organization shall pay a reasonable sum that the Commissioner finds to be the cost […]
(a) To qualify for a certificate of authority to operate as a health maintenance organization, an applicant shall satisfy the Commissioner that the applicant will meet the requirements of this section. (b) The applicant shall conform to the definition of a health maintenance organization. (c) The applicant shall establish and operate a bona fide health maintenance organization that […]
(a) (1) In this section the following words have the meanings indicated. (2) “Adjunct claims documentation” means an abstract of an enrollee’s medical record which describes and summarizes the diagnosis and treatment of, and services rendered to, the enrollee, including, in the case of trauma rendered in a trauma center, an operative report, a discharge summary, a Maryland […]
