Ch. 14

1997 LAWS OF MARYLAND

(vii) Shall provide services in accordance with funding restrictions
included in the annual State budget bill.

(3) Subject to restrictions in federal law or waivers, the Department may
impose cost-sharing on Program recipients.

(b) (1) As permitted by federal law or waiver, the Secretary may establish a
program under which Program recipients are required to enroll in managed care
organizations.

(2) (i) The benefits required by the program developed under paragraph
(1) of this subsection shall be adopted by regulation and shall be equivalent to the benefit
level required by the Maryland Medical Assistance Program on January 1, 1996.

(ii) Nothing in this paragraph may be construed to prohibit a managed
care organization from offering additional benefits, if the managed care organization is
not receiving capitation payments based on the provision of the additional benefits.

(3) Subject to the limitations of the State budget and as permitted by federal
law or waiver, the program developed under paragraph (1) of this subsection may provide
guaranteed eligibility for each enrollee for up to 6 months, unless an enrollee obtains
health insurance through another source.

(4) (i) The Secretary may exclude specific populations or services from
the program developed under paragraph (1) of this subsection.

(ii) For any populations or services excluded under this paragraph, the
Secretary may authorize a managed care organization, to provide the services or provide
for the population, including authorization of a separate dental managed care
organization or a managed care organization to provide services to Program recipients
with special needs.

(5) (i) Except for a service excluded by the Secretary under paragraph (4)
of this subsection, each managed care organization shall provide all the benefits required
by regulations adopted under paragraph (2) of this subsection.

(ii) For a population or service excluded by the Secretary under
paragraph (4) of this subsection, the secretary may authorize a managed care
organization to provide only for that population or provide only that service.

(iii) A managed care organization may subcontract specified required
services to a health care provider that is licensed or authorized to provide those services.

(6) Except for the Program of All-inclusive Care for the Elderly ("PACE")
Program, the Secretary may not include the long-term care population or long-term care
services in the program developed under paragraph (1) of this subsection.

(7) The program developed under paragraph (1) of this subsection shall
ensure that enrollees have access to a pharmacy that:

(i) Is licensed in the State; and

(ii) Is within a reasonable distance from the enrollee's residence.

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