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Session Laws, 1989
Volume 771, Page 5017   View pdf image
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WILLIAM DONALD SCHAEFER, Governor

(E) IN ADDITION TO THE COMMISSIONER'S AUTHORITY UNDER
ARTICLE 48A, SUBTITLE 10 OF THE CODE, THE COMMISSIONER AS A
LIQUIDATOR MAY, SUBJECT TO APPROVAL BY A COURT:

(1)  CONTRACT WITH A SOLVENT HEALTH MAINTENANCE
ORGANIZATION OR OTHER APPROPRIATE ENTITY TO OPERATE THE INSOLVENT
HEALTH MAINTENANCE ORGANIZATION, INCLUDING THE PROVISION OF
MEDICAL CARE, ON A SHORT-TERM BASIS;

(2)  OPERATE THE INSOLVENT HEALTH MAINTENANCE
ORGANIZATION, WHICH MAY INCLUDE COMPENSATING HEALTH CARE
PROVIDERS IN ACCORDANCE WITH THE TERMS OF THE HEALTH CARE
PROVIDER'S CONTRACT WITH THE INSOLVENT HEALTH MAINTENANCE
ORGANIZATION;

(3)  (I) DIRECT ALL OTHER HEALTH MAINTENANCE
ORGANIZATIONS THAT PARTICIPATED IN AN OPEN ENROLLMENT PROCESS
WITH THE INSOLVENT HEALTH MAINTENANCE ORGANIZATION AT A GROUP'S
LAST REGULAR OPEN ENROLLMENT PERIOD TO OFFER ENROLLEES OR
SUBSCRIBERS OF THE INSOLVENT HEALTH MAINTENANCE ORGANIZATION A
30-DAY OPEN ENROLLMENT PERIOD TO BEGIN ON THE DATE . OF THE
INSOLVENCY;

(II) EACH HEALTH MAINTENANCE ORGANIZATION
DIRECTED TO OFFER ENROLLEES OR SUBSCRIBERS OF THE INSOLVENT
HEALTH MAINTENANCE ORGANIZATION A 30-DAY OPEN ENROLLMENT PERIOD
SHALL OFFER THE ENROLLEES OF THE INSOLVENT HEALTH MAINTENANCE
ORGANIZATION THE SAME COVERAGE AND RATES THAT IT OFFERED THE
ENROLLEES AT THE LAST REGULAR OPEN ENROLLMENT PERIOD;

(4)  (I) EQUITABLY ALLOCATE THE INSOLVENT HEALTH
MAINTENANCE ORGANIZATION'S GROUP CONTRACTS OF THOSE GROUPS NOT
OFFERED OTHER COVERAGE UNDER PARAGRAPH (3) OF THIS SUBSECTION,
AMONG ALL HEALTH MAINTENANCE ORGANIZATIONS OPERATING WITHIN A
PORTION OF THE INSOLVENT HEALTH MAINTENANCE ORGANIZATION'S
SERVICE AREA;

(II)  BEFORE ALLOCATING THE GROUP CONTRACTS
UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH, THE COMMISSIONER SHALL
CONSIDER THE HEALTH CARE DELIVERY SYSTEM AND FINANCIAL RESOURCES
OF ALL POSSIBLE SUCCESSOR HEALTH MAINTENANCE ORGANIZATIONS;

(III)  EACH HEALTH MAINTENANCE ORGANIZATION
ALLOCATED A GROUP OR GROUPS UNDER SUBPARAGRAPH (I) OF THIS
PARAGRAPH SHALL OFFER THE GROUP OR GROUPS THE HEALTH MAINTENANCE
ORGANIZATION'S EXISTING COVERAGE WHICH IS MOST SIMILAR TO EACH
GROUP'S COVERAGE WITH THE INSOLVENT HEALTH MAINTENANCE
ORGANIZATION AT RATES DETERMINED IN ACCORDANCE WITH THE SUCCESSOR
HEALTH MAINTENANCE ORGANIZATION'S EXISTING RATE METHODOLOGY;

(IV)  ANY ENROLLEE OR SUBSCRIBER WHOSE GROUP
COVERAGE HAD TERMINATED PRIOR TO THE DATE OF THE INSOLVENCY AND

- 5017 -

 

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Session Laws, 1989
Volume 771, Page 5017   View pdf image
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