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LAWS OF MARYLAND

Ch. 21

ABUSE; AND

(XXVIII) ANY OTHER CARE, SERVICE, OR
TREATMENT OF DISEASE OR INJURY, THE CORRECTION OF DEFECTS,
OR THE MAINTENANCE OF THE PHYSICAL AND MENTAL WELL-BEING OF
HUMAN BEINGS.

REVISOR'S NOTE: This subsection formerly appeared as
Article 43, § 842(c).

The former phrase "but are not limited to" is
deleted as unnecessary in light of the use of the
defined term "includes".

The only other changes are in style.

Defined terms: "Includes"/"including" § 1-101
"Provider" § 19-701

(E) HEALTH MAINTENANCE ORGANIZATION.

"HEALTH MAINTENANCE ORGANIZATION" MEANS ANY PERSON,
INCLUDING A PROFIT OR NONPROFIT CORPORATION ORGANIZED UNDER
THE LAWS OF ANY STATE OR COUNTRY, THAT:

(1)  OPERATES OR PROPOSES TO OPERATE IN THIS
STATE;

(2)  EXCEPT AS PROVIDED IN § 19-703(B) OF THIS
SUBTITLE WITH RESPECT TO HOSPITALIZATION SERVICES, PROVIDES
OR OTHERWISE MAKES AVAILABLE TO ITS MEMBERS HEALTH CARE
SERVICES THAT INCLUDE AT LEAST PHYSICIAN, HOSPITALIZATION,
LABORATORY, X-RAY, EMERGENCY, AND PREVENTIVE SERVICES,
OUT-OF-AREA COVERAGE, AND ANY OTHER HEALTH CARE SERVICES
THAT THE COMMISSIONER DETERMINES TO BE AVAILABLE GENERALLY
ON AN INSURED OR PREPAID BASIS IN THE AREA. SERVICED BY THE
HEALTH MAINTENANCE ORGANIZATION, AND, AT THE OPTION OF THE
HEALTH MAINTENANCE ORGANIZATION, MAY PROVIDE ADDITIONAL
COVERAGE;

(3)  EXCEPT FOR ANY COPAYMENT OR DEDUCTIBLE
ARRANGEMENT, IS COMPENSATED ONLY ON A PREDETERMINED PERIODIC
RATE BASIS FOR PROVIDING TO MEMBERS THE MINIMUM SERVICES
THAT ARE SPECIFIED IN ITEM (2) OF THIS SUBSECTION;

(4)  ASSURES ITS SUBSCRIBERS AND MEMBERS, THE
COMMISSIONER, AND THE DEPARTMENT THAT ONE CLEARLY SPECIFIED
LEGAL AND ADMINISTRATIVE FOCAL POINT OR ELEMENT OF THE
HEALTH MAINTENANCE ORGANIZATION HAS THE RESPONSIBILITY OF
PROVIDING THE AVAILABILITY, ACCESSIBILITY, QUALITY, AND
EFFECTIVE USE OF COMPREHENSIVE HEALTH CARE SERVICES; AND

(5)  PRIMARILY PROVIDES SERVICES OF PHYSICIANS:

(I) DIRECTLY THROUGH PHYSICIANS WHO ARE