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PARRIS N. GLENDENING, Governor S.B. 497
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(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
(ii) The contracting provider administer payments pursuant to the
contract within WITH the health maintenance organization for the health care
services to the external providers.
(3) "Contracting provider" means a physician or other health-care
provider PERSON who enters into an administrative service provider contract with a
health maintenance organization.
(4) "External provider" means a health care provider, including a
physician or hospital, who is not:
(i) A contracting provider; or
(ii) An employee, shareholder, or partner of a contracting provider.
(B) THIS SECTION DOES NOT APPLY TO A CONTRACT BETWEEN A HEALTH
MAINTENANCE ORGANIZATION AND A CONTRACTING PROVIDER THAT IS
AFFILIATED WITH THE HEALTH MAINTENANCE ORGANIZATION THROUGH COMMON
OWNERSHIP WITHIN AN INSURANCE HOLDING COMPANY SYSTEM, IF THE HEALTH
MAINTENANCE ORGANIZATION:
(1) FILES WITH THE COMMISSIONER CONSOLIDATED FINANCIAL
STATEMENTS THAT INCLUDE THE CONTRACTING PROVIDER; AND
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- 3913 -
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