1382

LAWS OF MARYLAND

[Ch. 276

AND PREVENTIVE SERVICES, OUT-OF-AREA COVERAGE, AND OTHER
HEALTH CARE SERVICES WHICH ARE DETERMINED BY THE
COMMISSIONER TO BE GENERALLY AVAILABLE ON AN INSURED OR
PREPAID BASIS IN THE LOCALITY SERVICED BY THE
ORGANIZATION, AND MAY, AT THE ORGANIZATION'S OPTION,
PROVIDE ADDITIONAL COVERAGE;

(2)         IS COMPENSATED        (EXCEPT          FOR          ANY
CO-PAYMENT OR DEDUCTIBLE ARRANGEMENTS) FOR THE PROVISION
OF THE MINIMUM SERVICES SPECIFIED IN PARAGRAPH (1) OF
THIS SUBSECTION TO MEMBERS SOLELY ON A PREDETERMINED
PERIODIC RATE BASIS;

(3)          PROVIDES PHYSICIANS' SERVICES PRIMARILY:

(I)         DIRECTLY THROUGH PHYSICIANS WHO
ARE EITHER EMPLOYEES OR PARTNERS OF SUCH ORGANIZATIONS,
OR

(II)       UNDER ARRANGEMENTS WITH ONE OR
MORE GROUPS OF PHYSICIANS (ORGANIZED ON A GROUP PRACTICE
OR INDIVIDUAL PRACTICE BASIS) UNDER WHICH EACH GROUP:

(A)          IS COMPENSATED FOR ITS SERVICES
PRIMARILY ON THE BASIS OF AN AGGREGATE
FIXED SUM OR ON A PER CAPITA BASIS; AND

(B)             IS PROVIDED WITH AN EFFECTIVE
INCENTIVE TO AVOID UNNECESSARY INPATIENT
UTILIZATION, REGARDLESS OF WHETHER THE
INDIVIDUAL PHYSICIAN MEMBERS OF THE
GROUP ARE PAID ON A FEE-FOR-SERVICE OR
OTHER BASIS; AND

(4)            ASSURES TO ITS SUBSCRIBERS AND MEMBERS,
THE COMMISSIONER, AND THE DEPARTMENT OF HEALTH AND MENTAL
HYGIENE THAT ONE CLEARLY SPECIFIED LEGAL          AND
ADMINISTRATIVE FOCAL POINT OR ELEMENT OF THE ORGANIZATION
IS CHARGED WITH THE RESPONSIBILITY OF PROVIDING THE
AVAILABILITY, ACCESSIBILITY AND QUALITY (INCLUDING
EFFECTIVE UTILIZATION) OF COMPREHENSIVE HEALTH CARE
SERVICES.

(B)             "COMMISSIONER" MEANS THE STATE INSURANCE
COMMISSIONER OF MARYLAND,

(C)             "HEALTH CARE SERVICES" AS USED HEREIN MEANS
SERVICES, MEDICAL EQUIPMENT, AND SUPPLIES FURNISHED BY A
PROVIDER WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO:

(1)          MEDICAL CARE AND SERVICES;

(2)         SURGICAL CARE AND SERVICES;