PARRIS N. GLENDENING, Governor                             Ch. 333

1.       Is compensated for its services primarily on the basis of an
aggregate fixed sum or on a per capita basis; and

2.       Is provided with an effective incentive to avoid unnecessary
inpatient use, whether the individual physician members of the group are paid on a
fee-for-service or other basis.

(g) "Member" means a person who makes a contract or on whose behalf a
contract is made with a health maintenance organization for health care services.

(i) "Subscriber" means a person who makes a contract with a health maintenance
organization, either directly or through an insurer or marketing organization, under which
the person or other designated persons are entitled to the health care services.

19-703.

(a)     This subtitle does not:

(1)     Authorize any person to engage directly or indirectly in the practice of
any health occupation except as otherwise authorized by law;

(2)     Authorize any person to regulate, interfere, or intervene in the
relationship between any provider of health care services and the patients of the provider;
or

(3)     Prohibit any health maintenance organization from meeting the
requirements of any federal law that authorizes the health maintenance organization to:

(i) Receive federal financial assistance; or

(ii) Enroll beneficiaries assisted by federal funds.

(b)     A health maintenance organization or a part of it that is also a community
health center organized under the federal Public Health Service Act and receives federal
funds under 42 U.S.C. § 254c is not required to provide hospitalization for individuals for
whom services are provided by those funds.

(c)     Health maintenance organizations shall offer as an option to all of its
members or subscribers benefits for hospice services provided by a hospice care program,
as defined in § 19-901(c) of this title.

(d)     Health maintenance organizations shall provide continuation coverage
required under Article 48A, §§ 490G, 490H, and 490-I of the Code.

(e)     (1) Notwithstanding any other provision of this subtitle, a health
maintenance organization may offer a benefit package that provides at a minimum
benefits required by Article 48A, § 490-O of the Code for a limited benefits policy.

(2) A benefit package offered under paragraph (1) of this subsection shall:

(i) Be subject to the approval of the Insurance Commissioner; and

(ii) Satisfy the requirements of Article 48A, § 490-O of the Code.

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