Ch. 4

2004 LAWS OF MARYLAND

(III)   INCLUDE PROVISIONS FOR CONSUMER DIRECTION OF
PERSONAL ASSISTANCE SERVICES;

(IV)    ENSURE NECESSARY PROVIDER CAPACITY IN ALL GEOGRAPHIC
REGIONS WHERE THE COMMUNITY CARE ORGANIZATION IS APPROVED TO OPERATE;

(V)     BE ACCOUNTABLE, AND HOLD ITS SUBCONTRACTORS
ACCOUNTABLE, FOR MEETING ALL REQUIREMENTS, STANDARDS, CRITERIA, OR
OTHER DIRECTIVES OF THE DEPARTMENT AND UPON FAILURE TO MEET THOSE
STANDARDS, BE SUBJECT TO ONE OR MORE OF THE FOLLOWING PENALTIES:

1. FINES;

2.       SUSPENSION OF FURTHER ENROLLMENT;

3.       WITHHOLDING OF ALL OR PART OF A CAPITATION
PAYMENT;

4.       TERMINATION OF A CONTRACT;

5.       DISQUALIFICATION FROM FUTURE PARTICIPATION; AND

6.       ANY OTHER PENALTIES THAT MAY BE IMPOSED BY THE
SECRETARY;

(VI)    MEET THE SOLVENCY AND CAPITAL REQUIREMENTS FOR
HEALTHCHOICE MANAGED CARE ORGANIZATIONS UNDER THE INSURANCE ARTICLE;

(VII)  TO THE EXTENT PRACTICABLE, ALLOW WAIVER ENROLLEES,
WHO MEET THE NURSING HOME LEVEL OF CARE, TO SELECT A NURSING HOME,
ASSISTED LIVING FACILITY, OR ADULT DAY CARE FACILITY PROVIDED THAT THE
NURSING HOME, ASSISTED LIVING FACILITY, OR ADULT DAY CARE FACILITY IS
LICENSED BY THE DEPARTMENT AND THE PROVIDER MEETS THE
DEPARTMENT-APPROVED CREDENTIALING REQUIREMENTS OF THE COMMUNITY
CARE ORGANIZATION;

(VIII) SUBMIT TO THE DEPARTMENT UTILIZATION AND OUTCOME
REPORTS AS DIRECTED BY THE DEPARTMENT;

(IX) PROVIDE TIMELY ACCESS TO, AND CONTINUITY OF, HEALTH
AND LONG-TERM CARE SERVICES FOR ENROLLEES;

(X)     DEMONSTRATE ORGANIZATIONAL CAPACITY TO PROVIDE
SPECIAL POPULATION SERVICES, INCLUDING OUTREACH, CASE MANAGEMENT, AND
HOME VISITING, DESIGNED TO MEET THE INDIVIDUAL NEEDS OF ALL ENROLLEES;

(XI)    PROVIDE ASSISTANCE TO ENROLLEES IN SECURING
NECESSARY HEALTH AND LONG-TERM CARE SERVICES; AND

(XII)  COMPLY WITH ALL RELEVANT PROVISIONS OF THE FEDERAL
BALANCED BUDGET ACT OF 1997 (P.L. 105-33).

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