Ch. 500                                    1995 LAWS OF MARYLAND

Article - Health - General

15-103.

[(b) (1) The Program shall, as appropriate, include managed care pilot programs
for those groups of Program recipients who may benefit from a managed care program to
meet their health care needs.

(2) To the extent deemed feasible and appropriate, all managed care pilot
programs developed under the provisions of paragraph (1) of this subsection shall:

(i) Designate 1 person to be responsible for managing the delivery of
health care services to the Program recipient;

recipients;
recipients;
health habits;

(ii) Promote access to and continuity of health care to Program
(iii) Prevent unnecessary utilization of health care services by Program
(iv) Educate Program recipients on health care prevention and good

(v) Provide sufficient flexibility to enable the Managed Care Program
to be tailored to meet the individual health care needs of Program recipients; and

(vi) Promote assistance for Program recipients in securing necessary
health care services.

(3) All managed care pilot programs developed under the provisions of
paragraph (1) of this subsection shall be carefully controlled and evaluated as to their
health care outcomes and cost effectiveness.]

(B) (1) THE SECRETARY MAY ESTABLISH A PROGRAM UNDER WHICH
PROGRAM RECIPIENTS ARE REQUIRED TO ENROLL IN MANAGED CARE PLANS.

(2) A MANAGED CARE PLAN SHALL:

(I)      HAVE A QUALITY ASSURANCE PROGRAM IN EFFECT WHICH IS
SUBJECT TO THE APPROVAL OF THE DEPARTMENT;

(II)     COLLECT AND SUBMIT TO THE DEPARTMENT
SERVICE-SPECIFIC DATA BY SERVICE TYPE IN A FORMAT TO BE ESTABLISHED BY
THE DEPARTMENT;

                  (III) PROMOTE TIMELY ACCESS TO AND CONTINUITY OF HEALTH

CARE FOR PROGRAM RECIPIENTS;

(IV)   DEVELOP SPECIAL PROGRAMS TAILORED TO MEET THE
INDIVIDUAL HEALTH CARE NEEDS OF PROGRAM RECIPIENTS;

(V)     PROVIDE ASSISTANCE TO PROGRAM RECIPIENTS IN SECURING
NECESSARY HEALTH CARE SERVICES;

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