1622

LAWS OF MARYLAND

Ch. 572

(4) Exempt [prepaid health care plans] HEALTH
MAINTENANCE ORGANIZATIONS from the operation of the
insurance laws of the State, except to the extent and in the
manner set forth in this subtitle.

(c) The intention of the State in enacting this
subtitle is to encourage the formation of health maintenance
organizations by such diverse groups as nonprofit health
service plans; medical health service plans; medical care
foundations; groups of professionals, either in the form of
partnerships or professional corporations; consumer
sponsored organizations; or business or legal entities,
provided that they meet the necessary minimum qualifications
under this subtitle.

842.

(a) A "health maintenance organization" means any
organization[, person, medical care foundation, firm, or
corporation] OR PORTION OF AN ORGANISATION that operates or
proposes to operate in Maryland, including a profit or
nonprofit corporation organized under the laws of another
country, state, or the District of Columbia, which:

(1)   Provides or otherwise makes available to its
members health care services, as defined in subsection (c)
of this section, including, at a minimum, physician,
hospitalization, laboratory. X-ray, emergency 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; HOWEVER,

THOSE HEALTH MAINTENANCE ORGANIZATIONS OR PORTIONS OF

ORGANIZATIONS WHICH ARE ALSO COMMUNITY HEALTH CENTERS
ORGANIZED IN ACCORDANCE WITH THE PUBLIC HEALTH SERVICE ACT,
THAT RECEIVE FEDERAL FUNDS PURSUANT TO 42 U.S.C. § 254C MAY
NOT BE REQUIRED TO PROVIDE HOSPITALIZATION FOR PERSONS FOR
WHOM SERVICES ARE PROVIDED BY THOSE FUNDS;

(2)   Is compensated (except for any copayment 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