ROBERT L. EHRLICH, JR., Governor                             Ch. 461

(i) Providing 24-hour access by telephone to a person who is able
to appropriately respond to calls from members and providers concerning after-hours
care; and

(ii) Providing a 24-hour toll free telephone access system for use in
hospital emergency departments in accordance with § 19-705.7 of this subtitle;

(3)     A requirement that any nonparticipating provider shall submit to the
health maintenance organization the appropriate documentation of the medical
complaint of the member and the services rendered;

(4)     A requirement that a health maintenance organization shall have a
physician available at all times to provide diagnostic and treatment services;

(5)     A requirement that a health maintenance organization shall assure
that:

(i) Each member who is seen for a medical complaint is evaluated
under the direction of a physician; and

(ii) Each member who receives diagnostic evaluation or treatment
is under the [direct] medical management of a health maintenance organization
physician who provides continuing medical management;

(6)     A requirement that each member shall have an opportunity to select
a primary physician OR A CERTIFIED NURSE PRACTITIONER from among those
available to the health maintenance organization; and

(7)     A requirement that a health maintenance organization print, in any
directory of participating providers or hospitals, in a conspicuous manner, the
address, telephone number, and facsimile number of the State agency that members,
enrollees, and insureds may call to discuss quality of care issues, life and health
insurance complaints, and assistance in resolving billing and payment disputes with
the health plan or health care provider, as follows:

(i) For quality of care issues and life and health care insurance
complaints, the Maryland Insurance Administration; and

(ii) For assistance in resolving a billing or payment dispute with
the health plan or a health care provider, the Health Education and Advocacy Unit of
the Consumer Protection Division of the Office of the Attorney General.

(C) (1) A MEMBER MAY SELECT A CERTIFIED NURSE PRACTITIONER AS THE
MEMBER'S PRIMARY CARE PROVIDER IF:

(I)      THE CERTIFIED NURSE PRACTITIONER PROVIDES SERVICES AT
THE SAME LOCATION AS THE CERTIFIED NURSE PRACTITIONER'S COLLABORATING
PHYSICIAN; AND

(II)     THE COLLABORATING PHYSICIAN PROVIDES THE CONTINUING
MEDICAL MANAGEMENT REQUIRED UNDER SUBSECTION (B)(5) OF THIS SECTION.

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