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Home » US Law » 2022 Maryland Statutes » Health - General » Title 19 - Health Care Facilities » Subtitle 7 - Health Maintenance Organizations

Section 19-710.2 – Point-of-Service Option

    (a)    (1)    In this section the following words have the meanings indicated.         (2)    “Carrier” means:             (i)    An insurer;             (ii)    A nonprofit health service plan;             (iii)    A health maintenance organization;             (iv)    A dental plan organization; or             (v)    Any other person or organization that provides health benefit plans subject to State regulation.         (3)    “Point-of-service option” means a health benefit plan that permits a member or subscriber […]

Section 19-711 – Issuance of Certificate of Authority; Merger, Consolidation, etc., With Domestic Health Maintenance Organization

    (a)    Within 90 days after the filing of an application for a certificate of authority to operate as a health maintenance organization, the Commissioner shall issue the certificate of authority to the applicant if:         (1)    The application conforms with § 19-708 of this subtitle;         (2)    The applicant has paid the fees required by § 19-709 of this subtitle; […]

Section 19-712 – Powers and Authority of Health Maintenance Organization

    (a)    Subject to the provisions of subsection (b) of this section, a person who holds a certificate of authority to operate a health maintenance organization under this subtitle may:         (1)    Exercise the power that professional and other corporations, partnerships, associations, or other business entities have under their organizational documents and any laws of this State that do […]

Section 19-712.2 – Notice to Pharmacies of Change in Pharmaceutical Benefits

    (a)    A health maintenance organization that provides pharmaceutical benefits shall notify all pharmacies under contract with the health maintenance organization in writing of changes in the pharmaceutical benefit program rules or requirements at least 30 days before the change is effective.     (b)    Changes that require 30 days’ advance written notice under subsection (a) of this section are: […]

Section 19-712.4 – Prohibited Referrals

    (a)    In this section the terms “health care practitioner”, “health care entity”, and “health care service” have the same meanings as provided in § 1–301 of the Health Occupations Article.     (b)    A health maintenance organization may seek repayment from a health care practitioner of any money paid for any claim, bill, or other demand or request for […]

Section 19-712.5 – Reimbursement for Hospital Emergency Facility and Provider

    (a)    A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable co–payments, for medically necessary services provided to a member or subscriber of the health maintenance organization if the health maintenance organization authorized, directed, referred, or otherwise allowed the member or subscriber to use the emergency facility and the medically necessary […]

Section 19-712.6 – Continuing Care Facility

    (a)    Whenever a subscriber or an enrollee of a health maintenance organization is a resident of a continuing care facility that is regulated under Title 10, Subtitle 4 of the Human Services Article and received health care services in an acute care health care facility, the resident’s primary care physician shall refer, if medically appropriate, the […]

Section 19-712.7 – Reimbursement to Community Health Resources

    To the extent required under federal law, a health maintenance organization shall reimburse a community health resource, as defined in § 19-2101 of this title, for covered services provided to a member or subscriber of the health maintenance organization.

Section 19-713 – Rates and Contracts

    (a)    (1)    Each health maintenance organization shall file with the Commissioner and pay the applicable filing fee as provided in § 2–112 of the Insurance Article, before they become effective:             (i)    All rates that the health maintenance organization charges subscribers or groups of subscribers; and             (ii)    The form and content of each contract between the health maintenance organization and […]

Section 19-713.1 – Contracts Between Health Maintenance Organization and Subscribers

    (a)    A contract between a health maintenance organization and its subscribers or a group of subscribers may contain nonduplication provisions or provisions to coordinate the coverage with subscriber contracts of other health maintenance organizations, health insurance policies, including those of nonprofit health service plans, and with other established programs under which the subscriber or member may […]

Section 19-713.2 – Administrative Service Provider Contracts

    (a)    (1)    In this section the following words have the meanings indicated.         (2)    “Administrative service provider contract” means a contract or capitation agreement between a health maintenance organization and a contracting provider which includes requirements that:             (i)    The contracting provider accept payments from a health maintenance organization for health care services to be provided to members of the health […]

Section 19-713.3 – Administrative Service Contracting Provider

    (a)    (1)    In this section the following words have the meanings indicated.         (2)    “Administrative service provider contract” has the meaning stated in § 19-713.2 of this subtitle.         (3)    “Contracting provider” has the meaning stated in § 19-713.2 of this subtitle.     (b)    (1)    A person must register with the Commissioner before the person acts as a contracting provider in this State.         (2)    A […]

Section 19-713.4 – Providing Pharmaceutical Services

    (a)    In this section, “health maintenance organization” or “HMO” includes any agent of a health maintenance organization.     (b)    (1)    A health maintenance organization that issues a request for proposal, including changes in terms to an existing contract to provide pharmaceutical services, shall notify the Maryland Pharmacists Association of the request for proposal to provide pharmaceutical services within 10 […]

Section 19-713.5 – Uniform Consultation Referral Form

    (a)    If a health maintenance organization requires its subscribers to have a referral to receive consultation services in writing, the health maintenance organization shall use the uniform consultation referral form adopted by the Commissioner under § 15-120 of the Insurance Article as the sole instrument for referrals for consultation services.     (b)    A health maintenance organization may not […]

Section 19-713.6 – Drug Therapy Management

    (a)    (1)    In this section the following words have the meanings indicated.         (2)    “Documented informed consent” means:             (i)    A written consent form signed by a patient; or             (ii)    Verbal or otherwise communicated consent signified by a notation in a patient’s electronic medical record maintained by a group model health maintenance organization.         (3)    “Drug therapy management” means treatment of a patient using […]

Section 19-714 – Marketing Documents

    Each marketing document that sets forth the health care services of a health maintenance organization shall describe fully and clearly:         (1)    The health care services under each benefit package and every other benefit to which a member is entitled;         (2)    Where and how services may be obtained;         (3)    Each exclusion or limitation on any service or other benefit […]

Section 19-715 – Application or Offer of Enrollment

    Each health maintenance organization application or offer of enrollment shall contain or be accompanied by, and each form of health maintenance organization subscriber contract shall contain, a full and clear statement of:         (1)    The items specified in § 19-714 of this subtitle;         (2)    The rate of periodic payment;         (3)    When the coverage is effective and what restrictions, if […]

Section 19-716 – Availability of Information to Members and General Public

    Annually, each health maintenance organization shall provide to its members and make available to the general public, in clear, readable, and concise form:         (1)    A summary of the most recent financial report that the health maintenance organization submits to the Commissioner under § 19-717 of this subtitle;         (2)    A description of the benefit packages available and the […]

Section 19-717 – Annual Reports

    (a)    Except as provided in subsections (b) and (c) of this section and unless, for good cause shown, the Commissioner extends the time for a reasonable period:         (1)    On or before March 1 of each year, each health maintenance organization shall file with the Commissioner a report that shows the financial condition of the health maintenance organization […]