3128

LAWS OF MARYLAND

Ch. 816

(VI) A STATISTICALLY REPRESENTATIVE SAMPLE OF
MEMBER RECORDS.

19-710.

(f) (1) The terms of the contracts to be offered to
subscribers shall provide that the health care services provided
to members of the health maintenance organization will meet
reasonable standards of quality of care that are applicable to
the geographic area to be served, as approved by the Department.

(2) IF A . HEALTH MAINTENANCE ORGANIZATION OFFERS
SERVICES THAT ARE WITHIN THE SCOPE OF PRACTICE OF A PHYSICIAN AND
ANOTHER HEALTH CARE PRACTITIONER WHO IS LICENSED UNDER THE HEALTH
OCCUPATIONS ARTICLE, THE HEALTH MAINTENANCE ORGANIZATION SHALL
OFFER ITS SUBSCRIBERS THOSE SERVICES THROUGH A PHYSICIAN OR THE
OTHER HEALTH CARE PRACTITIONER. OFFER THOSE SERVICES THROUGH
OTHER LICENSED HEALTH CARE PRACTITIONERS, WHERE APPROPRIATE, AS
DETERMINED BY THE HEALTH MAINTENANCE ORGANIZATION.

19-728.

(C) (1) IF THE COMMISSIONER DETERMINES THAT A HEALTH
MAINTENANCE ORGANIZATION IS NOT OPERATING IN A FISCALLY SOUND
MANNER, THE COMMISSIONER SHALL NOTIFY THE DEPARTMENT OF THE
DETERMINATION.

(2) AFTER THE DEPARTMENT RECEIVES NOTICE IN
ACCORDANCE WITH THE PROVISIONS OF PARAGRAPH (1) OF THIS
SUBSECTION, THE DEPARTMENT SHALL MONITOR THE HEALTH MAINTENANCE
ORGANIZATION ON A CONTINUOUS BASIS UNTIL THE DEPARTMENT
DETERMINES THAT THE HEALTH MAINTENANCE ORGANIZATION IS OPERATING
IN A FISCALLY SOUND MANNER.

19-729.

(a) A health maintenance organization may not:

(7)  Fraudulently obtain or fraudulently attempt to
obtain any benefit under this subtitle; [or]

(8)  Fail to fulfill the basic requirements to operate
as a health maintenance organization as provided in § 19-710 of
this subtitle; OR

(9)  FAIL TO PROVIDE SERVICES TO A MEMBER IN A TIMELY
MANNER AS PROVIDED IN § 19-705.1(B)(1) OF THIS SUBTITLE.

19-730.

If any person violates any provision of § 19-729 of this
subtitle, the Commissioner may;

(1) [Suspend or revoke the certificate of authority
to do business as a health maintenance organization;