H.B. 1203

VETOES

1.       Develop and publicize procedures to assure that the health
maintenance organization is notified of the services and receives adequate documentation
of the services; [and]

2.       Develop and provide informational materials to all
subscribers and enrollees of the health maintenance organization that clearly describe
and inform subscribers and enrollees of their potential responsibility for payment for
services rendered by a health care provider, including a physician or hospital, that does
not have a written contract with the health maintenance organization; AND

3.        DEVELOP AND PROVIDE SPECIFIC INFORMATION TO ALL
SUBSCRIBERS AND ENROLLEES OF THE HEALTH MAINTENANCE ORGANIZATION
THAT CLEARLY DESCRIBES THE PROCEDURES TO BE FOLLOWED FOR EMERGENCY
SERVICES, INCLUDING:

A.       THE APPROPRIATE USE OF HOSPITAL EMERGENCY
ROOMS;

B.       THE APPROPRIATE USE, LOCATION, AND HOURS OF
OPERATION OF ANY URGENT CARE FACILITIES OPERATED BY THE HEALTH
MAINTENANCE ORGANIZATION; AND

C.       THE POTENTIAL RESPONSIBILITY OF SUBSCRIBERS AND
ENROLLEES FOR PAYMENT FOR EMERGENCY SERVICES OR NONEMERGENCY
SERVICES RENDERED IN A HOSPITAL EMERGENCY FACILITY PURSUANT TO §
19-710(Q) OF THIS SUBTITLE.

19-710.

(Q) NOTWITHSTANDING ANY OTHER PROVISION OF THIS SECTION, A
HOSPITAL EMERGENCY FACILITY OR A HOSPITAL EMERGENCY HEALTH CARE
PROVIDER MAY COLLECT OR ATTEMPT TO COLLECT PAYMENT: FROM A SUBSCRIBER
OR ENROLLEE FOR HEALTH CARE SERVICES PROVIDED TO THAT SUBSCRIBER OR
ENROLLEE FOR A MEDICAL CONDITION THAT IS DETERMINED NOT TO BE AN
EMERGENCY AS DEFINED IN § 19-701(D) OF THIS SUBTITLE

(1) FROM A SUBSCRIBER OR ENROLLEE WHO IS NOT CONTESTING THE
REFUSAL OF THE HEALTH MAINTENANCE ORGANIZATION TO PAY FOR THE
EMERGENCY SERVICES; AND

(2) FROM OTHER SUBSCRIBERS OR ENROLLEES AFTER THE
CONCLUSION OF ANY PROCEEDING THAT SUSTAINS THE REFUSAL OF THE HEALTH
MAINTENANCE ORGANIZATION TO PAY FOR THE EMERGENCY SERVICES FROM A
SUBSCRIBER OR ENROLLEE FOR HEALTH CARE SERVICES PROVIDED TO THAT
SUBSCRIBER OR ENROLLEE FOR A MEDICAL CONDITION THAT IS DETERMINED NOT TO
BE AN EMERGENCY AS DEFINED IN § 19-701(D) OF THIS SUBTITLE.

SECTION 3. AND BE IT FURTHER ENACTED, That, in enacting the
definition of "emergency services" in Section 2 of this Act without a reference to the
reasonable expectation of a "prudent layperson, who possesses an average knowledge of
health and medicine", the General Assembly intended to conform the standard to the
language of Public Law 99-272, April 7, 1986.

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