Parris N. Glendening
Governor

Senate Bill 475

AN ACT concerning

Continuity of Patient Care Act

FOR the purpose of requiring a health maintenance organization that allows a
member or subscriber to receive certain emergency medical services, under
certain circumstances, to reimburse a physician in an urgent care facility
certain health care provider who provides certain medically necessary follow-up
care to a member or subscriber of the health maintenance organization;
prohibiting a health maintenance organization, under certain circumstances,
from imposing on a member or subscriber any co-payment or other cost-sharing
requirement that exceeds what the member or subscriber is required to pay for
services rendered by a physician health care provider who is a member of the
provider panel of the health maintenance organization; providing for the
application of this Act; and generally relating to health maintenance
organizations.

BY adding to

Article - Health - General
Section 19-713.7 19-712.5(f)
Annotated Code of Maryland

(1996 Replacement Volume and 1998 Supplement)

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:

Article - Health - General

19-712.7.

IF A HEALTH MAINTENANCE ORGANIZATION AUTHORIZES, DIRECTS, REFERS,
OR OTHERWISE ALLOWS A MEMBER OR SUBSCRIBER OF THE HEALTH MAINTENANCE
ORGANIZATION TO USE A MEDICAL FACILITY THAT PROVIDES IMMEDIATE URGENT
CARE SERVICES FOR A CONDITION THAT READILY NECESSITATES A SURGICAL
PROCEDURE, THE HEALTH MAINTENANCE ORGANIZATION.

(1) SHALL REIMBURSE A PHYSICIAN IN THE URGENT CARE FACILITY
FOR PROVIDING ANY MEDICALLY NECESSARY FOLLOW UP CARE RELATED TO THE
CONDITION FOR WHICH THE SURGICAL PROCEDURE WAS PERFORMED; AND

(2) MAY NOT IMPOSE ON THE MEMBER OR SUBSCRIBER ANY
CO PAYMENT OR OTHER COST SHARING REQUIREMENT THAT EXCEEDS WHAT THE
MEMBER OR SUBSCRIBER IS REQUIRED TO PAY FOR SERVICES RENDERED BY A
PHYSICIAN WHO IS A MEMBER OF THE PROVIDER PANEL OF THE HEALTH
MAINTENANCE ORGANIZATION.