3126

LAWS OF MARYLAND

Ch. 816

(IV) A DESCRIPTION OF COMMUNITY HEALTH
RESOURCES AND HOW THEY WILL BE USED.

(3)  THE HEALTH MAINTENANCE ORGANIZATION SHALL STATE
ITS PRIORITIES AND OBJECTIVES IN WRITING, DESCRIBING HOW THE
PRIORITIES AND OBJECTIVES RELATING TO THE HEALTH PROBLEMS AND
NEEDS OF THE MEMBER POPULATION WILL BE PROVIDED FOR.

(4) THE HEALTH MAINTENANCE ORGANIZATION SHALL PROVIDE
A GENERAL DESCRIPTION OF THE SERVICES AVAILABLE TO ITS MEMBERS,
INCLUDING TYPE OF SERVICES, HOURS, SERVICES OFFERED, TYPES OF
PERSONNEL WHO WILL PROVIDE SERVICES, AND REFERRAL ARRANGEMENTS.

(4) (I) THE HEALTH MAINTENANCE ORGANIZATION SHALL
PROVIDE AT THE TIME MEMBERSHIP IS SOLICITED A GENERAL DESCRIPTION
OF THE BENEFITS AND SERVICES AVAILABLE TO ITS MEMBERS, INCLUDING
BENEFIT LIMITATIONS AND EXCLUSIONS, LOCATION OF FACILITIES OR
PROVIDERS, AND PROCEDURES TO OBTAIN MEDICAL SERVICES.

(II) THE HEALTH MAINTENANCE ORGANIZATION SHALL
PLACE THE FOLLOWING STATEMENT, IN BOLD PRINT, ON EVERY ENROLLMENT
CARD OR APPLICATION: "IF YOU HAVE ANY QUESTIONS CONCERNING THE
BENEFITS AND SERVICES THAT ARE PROVIDED BY OR EXCLUDED UNDER THIS
AGREEMENT, PLEASE CONTACT A MEMBERSHIP SERVICES REPRESENTATIVE
BEFORE SIGNING THIS APPLICATION OR CARD.

(5)  THE PLAN SHALL CONTAIN EVIDENCE THAT:

(I)  THE PROGRAMS AND SERVICES OFFERED ARE BASED
ON THE HEALTH PROBLEMS OF AND THE COMMUNITY HEALTH SERVICES
AVAILABLE TO ITS MEMBER POPULATION;

(II)  THERE IS AN ACTIVE PROGRAM FOR PREVENTING
ILLNESS, DISABILITY, AND HOSPITALIZATION AMONG ITS MEMBERS; AND

(III)  THE SERVICES DESIGNED TO PREVENT THE
MAJOR HEALTH PROBLEMS IDENTIFIED AMONG CHILD AND ADULT MEMBERS
AND TO IMPROVE THEIR GENERAL HEALTH ARE PROVIDED BY THE HEALTH
MAINTENANCE ORGANIZATION.

(E) (1) THE HEALTH MAINTENANCE ORGANIZATION SHALL HAVE AN
INTERNAL PEER REVIEW SYSTEM THAT WILL EVALUATE THE UTILIZATIONAL
SERVICES AND THE QUALITY OF HEALTH CARE PROVIDED TO ITS MEMBERS.

(2) THE REVIEW SYSTEM SHALL:

(I)  PROVIDE FOR REVIEW BY APPROPRIATE HEALTH
PROFESSIONALS OF THE PROCESS FOLLOWED IN THE PROVISION OF HEALTH
SERVICES;

(II)  USE SYSTEMATIC DATA COLLECTION OF
PERFORMANCES AND PATIENT RESULTS;

(III)  PROVIDE INTERPRETATION OF THIS DATA TO
THE PRACTITIONERS;