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Ch. 323
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2000 LAWS OF MARYLAND
(i) Covered under the subscriber's contract; and
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(ii) Rendered by a provider, who is not the person or entity which
entered into the administrative service provider contract with the health
maintenance organization, pursuant to a referral by a person or entity which entered
into the administrative service provider contract with the health maintenance
organization.
(2) Responsibility for claims and payments under this subsection is
subject to the provisions of I§ 19-712.1 of this subtitle] § 15-1005 OF THE INSURANCE
ARTICLE.
(C) THE RESPONSIBILITY OF A HEALTH MAINTENANCE ORGANIZATION FOR
CLAIMS OR PAYMENTS FOR HEALTH CARE SERVICES IN ACCORDANCE WITH
SUBSECTION (B) OF THIS SECTION UNDER AN ADMINISTRATIVE SERVICE PROVIDER
CONTRACT:
(1) IS NOT LIMITED BY THE AMOUNT IN A SEGREGATED FUND
ESTABLISHED UNDER § 19-713.2 OF THIS TITLE;
(2) EXISTS IRRESPECTIVE OF THE INSOLVENCY OR OTHER INABILITY OR
FAILURE OF A CONTRACTING PROVIDER, AS DEFINED IN S 19-713.2 OF THIS
SUBTITLE, TO PAY;
(3) EXISTS IRRESPECTIVE OF THE DELEGATION OR FURTHER
SUBCONTRACTING OF HEALTH CARE SERVICES BY A CONTRACTING PROVIDER TO AN
EXTERNAL PROVIDER AS DEFINED IN § 19-713.2 OF THIS SUBTITLE;
(4) MAY NOT BE ALTERED BY CONTRACT; AND
(5) APPLIES TO ALL HEALTH CARE SERVICES, INCLUDING THOSE
PROVIDED UNDER STATE AND FEDERAL PROGRAMS, UNLESS PREEMPTED BY
FEDERAL LAW.
(D) SUBSECTIONS (B) AND (C) OF THIS SECTION APPLY TO A CONTRACT
BETWEEN A HEALTH MAINTENANCE ORGANIZATION AND ANY COMPANY AFFILIATED
WITH THE HEALTH MAINTENANCE ORGANIZATION THROUGH COMMON OWNERSHIP
WITHIN AN INSURANCE HOLDING COMPANY SYSTEM, THAT MEETS THE DEFINITION
OF A CONTRACTING PROVIDER UNDER § 19-713.2 OF THIS SUBTITLE.
[19-713.2.
(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 maintenance organization that the contracting provider arranges to be
provided by external providers; and
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- 1924 -
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