PARRIS N. GLENDENING, Governor

Ch. 35

(1) COMMERCIAL INSURERS, NONPROFIT HEALTH SERVICE PLANS, AND
HEALTH MAINTENANCE ORGANIZATIONS THAT OPERATE IN THE STATE UNDER A
CERTIFICATE OF AUTHORITY;

(2) GROUP HEALTH PLANS, AS DEFINED IN § 607(1) OF THE EMPLOYEE
RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA); AND

(3) PERSONS THAT OFFER A SERVICE BENEFIT PLAN, AS DEFINED IN
FEDERAL LAW.

(C) ELIGIBILITY FOR BENEFITS.

AN ENTITY SUBJECT TO THIS SECTION MAY NOT CONSIDER WHETHER AN
INDIVIDUAL IS ELIGIBLE FOR OR RECEIVES MEDICAL ASSISTANCE FROM THIS
STATE OR ANOTHER STATE UNDER 42 U.S.C. § 1396A WHEN:

(1) DETERMINING THE ELIGIBILITY OF THE INDIVIDUAL FOR
ENROLLMENT IN HEALTH INSURANCE COVERAGE; OR

(2) CALCULATING ANY PAYMENTS FOR BENEFITS FOR WHICH THE
INDIVIDUAL IS ELIGIBLE UNDER THE HEALTH INSURANCE COVERAGE.

(D) REIMBURSEMENT OF STATE.

ON PRESENTATION OF A CLAIM, AN ENTITY SUBJECT TO THIS SECTION SHALL
REIMBURSE THE STATE TO THE EXTENT THAT:

(1) THE STATE HAS PAID FOR EXPENSES FOR HEALTH CARE SERVICES
THAT ARE PROVIDED TO AN ELIGIBLE INDIVIDUAL AND COVERED UNDER THE
MARYLAND MEDICAL ASSISTANCE PROGRAM; AND

(2) THOSE HEALTH CARE SERVICES ARE INCLUDED UNDER THE
INDIVIDUAL'S HEALTH INSURANCE COVERAGE PROVIDED BY THE ENTITY.

'(E) IMPOSITION OF DIFFERENT REQUIREMENTS ON STATE AGENCY
PROHIBITED.

IF A STATE AGENCY HAS BEEN ASSIGNED THE RIGHTS OF AN INDIVIDUAL WHO
IS ELIGIBLE FOR MEDICAL ASSISTANCE AND WHO HAS HEALTH INSURANCE
COVERAGE PROVIDED BY AN ENTITY SUBJECT TO THIS SECTION, THE ENTITY MAY
NOT IMPOSE ON THE STATE AGENCY REQUIREMENTS THAT ARE DIFFERENT FROM
THE REQUIREMENTS THAT APPLY TO AN AGENT, ASSIGNEE, OR ANY OTHER
INDIVIDUAL WHO HAS HEALTH INSURANCE COVERAGE PROVIDED BY THE ENTITY.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, § 490X.

In subsection (a) of this section, the former phrase "through an insurer" is
deleted as surplusage. Under this section, health care coverage may be
provided through entities other than insurers,

Subsection (b) of this section is revised as a scope provision rather than a
definition of "insurer" to clarify that this section applies to certain types of

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