WILLIAM DONALD SCHAEFER, Governor

Ch. 269

(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:

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

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.

(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.

SECTION 2. AND BE IT FURTHER ENACTED, That this Act may not be
interpreted to require preauthorization for emergency services as defined in § 19-701 (d) of the
Health - General Article.

SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 1994. January 1, 1995.

- 1763 -