HARRY HUGHES, Governor

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EITHER EMPLOYEES OR PARTNERS OF THE HEALTH MAINTENANCE
ORGANIZATION; OR

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

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

2.   IS PROVIDED WITH AN EFFECTIVE
INCENTIVE TO AVOID UNNECESSARY INPATIENT USE, WHETHER THE
INDIVIDUAL PHYSICIAN MEMBERS OF THE GROUP ARE PAID ON A
FEE-FOR-SERVICE OR OTHER BASIS.

REVISOR'S NOTE: This subsection formerly appeared as
Article 43, § 842(a), except the second clause of
item (1) of that subsection.

In the introductory clause of this subsection,
the former reference to "the District of
Columbia" is deleted as unnecessary in light of
the definition of "state".

The only other changes are in style.

Defined terms: "Commissioner" § 19-701
"Department" § 1-101 "Physician" § 1-101
'"Includes"/"including" § 1-101 "State" § 1-101
"Health care services" § 19-701
"Member" § 19-701 "Subscriber" § 19-701
"Person" § 1-101

(F) MEMBER.

"MEMBER" MEANS A PERSON WHO MAKES A CONTRACT OR ON
WHOSE BEHALF A CONTRACT IS MADE WITH A HEALTH MAINTENANCE
ORGANIZATION FOR HEALTH CARE SERVICES.

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

The former reference to a member being referred
to as an "enrollee" is deleted as unnecessary,
since that term was not used in the former law.
However, there is no intention to prohibit the
use of the term by the deletion.

The only other changes are in style.

Defined terms: "Health care services" § 19-70.1
"Health maintenance organization" § 19-701
"Person" § 1-101