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ROBERT L. EHRLICH, JR., Governor
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Ch. 193
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(2) Subject to § 10-212 of the State Government Article, any party
aggrieved by a decision in a contested case for which an appeal is provided to the
Board may appeal directly to the Board.
(f) (1) The Board shall adopt procedural rules and regulations as provided
in the Administrative Procedure Act and in all respects shall be governed by that Act.
At least 3 members shall sit at each hearing of the Board when it sits as a board of
appeal. Decisions shall be by a majority of the members sitting, shall be in writing,
and shall state the Board's reasons. The Board shall keep minutes of its proceedings.
(2) A decision of the Board is a final agency decision for purposes of
judicial review under the Administrative Procedure Act or any other law that permits
an appeal to the courts from a decision of a unit in the Department.
(g) (1) As to any issue for which the taking of evidence is authorized, the
chairman or the acting chairman may administer oaths and issue subpoenas and
orders for the attendance of witnesses and the production of evidence.
(2) If a person fails to comply with a lawful order or subpoena issued
under this subsection, on the petition of the chairman or acting chairman, a court of
competent jurisdiction may compel obedience to the order or subpoena or compel
testimony or the production of evidence.
(h) Unless there is a special provision of law governing an appeal of a decision
of a particular unit, each appeal from a decision of the Board shall be governed by the
Administrative Procedure Act.
SECTION 2. AND BE IT FURTHER ENACTED, That:
(a) Prior to making any adjustments to capitation payments for a managed
care organization, the Secretary of Health and Mental Hygiene, in consultation with
the Maryland Insurance Commissioner, shall adopt regulations to implement the
provisions of § 15-605(c)(5) of the Insurance Article.
(b) The regulations adopted under subsection (a) of this section shall:
(1) establish the definition of "loss ratio" for uniform application by all
managed care organizations;
(2) establish procedures requiring the Secretary of Health and Mental
Hygiene to consider the financial performance of a managed care organization in
prior periods;
(3) establish standard data collection and reporting requirements for all
managed care organizations;
(4) consistent with the provisions of § 15-605(c)(5) of the Insurance
Article, establish a process for allowing a managed care organization to appeal a
decision of the Secretary of Health and Mental Hygiene to adjust a managed care
organization's capitation payments; and
(5) establish a mechanism for, and conditions under which, an
adjustment to the capitation rates of a managed care organization are made.
- 1147 -
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