3124                                          LAWS OF MARYLAND                                      Ch. 816

19-705.1.

(A)  THE SECRETARY SHALL ADOPT REGULATIONS THAT SET OUT
REASONABLE STANDARDS OF QUALITY OF CARE THAT A HEALTH MAINTENANCE
ORGANIZATION SHALL PROVIDE TO ITS MEMBERS.

(B)  THE STANDARDS OF QUALITY OF CARE SHALL INCLUDE:

(1)  A REQUIREMENT THAT A HEALTH MAINTENANCE
ORGANIZATION SHALL PROVIDE FOR REGULAR HOURS DURING WHICH A
MEMBER MAY RECEIVE SERVICES, INCLUDING PROVIDING FOR SERVICES TO
A MEMBER IN A TIMELY MANNER THAT TAKES INTO ACCOUNT THE IMMEDIACY
OF NEED FOR SERVICES;

(2)  (I) A REQUIREMENT THAT A HEALTH MAINTENANCE
ORGANIZATION SHALL HAVE A SYSTEM FOR PROVIDING A MEMBER WITH
24-HOUR ACCESS TO A PHYSICIAN IN CASES WHERE THERE IS AN
IMMEDIATE NEED FOR MEDICAL SERVICES;

(II)  TO MEET THIS REQUIREMENT FOR OFF-HOUR
SERVICES, THE HEALTH MAINTENANCE ORGANIZATION MAY PROVIDE FOR
ACCESS TO A PHYSICIAN WHO DOES NOT HAVE A CONTRACT WITH THE
HEALTH MAINTENANCE ORGANIZATION OR A FACILITY, SUCH AS A HOSPITAL
EMERGENCY ROOM; AND

(III)  IF A PHYSICIAN WHO DOES NOT HAVE A
CONTRACT WITH A HEALTH MAINTENANCE ORGANIZATION IS USED OR A
FACILITY THAT IS NOT CONNECTED WITH A HEALTH MAINTENANCE
ORGANIZATION IS USED, THE HEALTH MAINTENANCE ORGANIZATION SHALL
DEVELOP AND PUBLICIZE PROCEDURES TO ASSURE THAT THE HEALTH
MAINTENANCE ORGANIZATION IS NOTIFIED OF THE SERVICES AND RECEIVES
ADEQUATE DOCUMENTATION OF THE SERVICES;

(3)  A REQUIREMENT THAT A HEALTH MAINTENANCE
ORGANIZATION SHALL HAVE A PHYSICIAN AVAILABLE AT ALL TIMES TO
PROVIDE DIAGNOSTIC AND TREATMENT SERVICES;

(4)  A REQUIREMENT THAT A HEALTH MAINTENANCE
ORGANIZATION SHALL ASSURE THAT:

(I)  EACH MEMBER WHO IS SEEN FOR A MEDICAL
COMPLAINT IS EVALUATED UNDER THE DIRECTION OF A PHYSICIAN; AND

(II)  EACH MEMBER WHO RECEIVES DIAGNOSTIC
EVALUATION OR TREATMENT IS UNDER THE DIRECT MEDICAL MANAGEMENT OF
A HEALTH MAINTENANCE ORGANIZATION PHYSICIAN WHO PROVIDES
CONTINUING MEDICAL MANAGEMENT; AND

(5)  A REQUIREMENT THAT EACH MEMBER SHALL HAVE AN
OPPORTUNITY TO SELECT A PRIMARY PHYSICIAN FROM AMONG THOSE
AVAILABLE TO THE HEALTH MAINTENANCE ORGANIZATION.

(C)  (1) THE HEALTH MAINTENANCE ORGANIZATION SHALL MAKE
AVAILABLE AND ENCOURAGE APPROPRIATE HISTORY AND BASELINE