Ch. 352

1996 LAWS OF MARYLAND

(II)    A PROVIDER WITH A PROGRAM FOR THE TRAINING OF HEALTH
CARE PROFESSIONALS, INCLUDING AN ACADEMIC MEDICAL CENTER;

(III)  A HOSPITAL OUTPATIENT PROGRAM, PHYSICIAN, OR ADVANCED
PRACTICE NURSE THAT IS A MARYLAND ACCESS TO CARE (MAC) PROVIDER;

(IV)   A LOCAL HEALTH DEPARTMENT;

(V) A HOSPICE AS DEFINED IN TITLE 19, SUBTITLE 9 OF THIS
ARTICLE;

(VI)   A PHARMACY; AND

(VII)  ANY OTHER HISTORIC PROVIDER DESIGNATED IN ACCORDANCE
WITH REGULATIONS ADOPTED BY THE DEPARTMENT.

(e) (F) (E) "Managed care [plan] ORGANIZATION" means AN
ORGANIZATION OR PROGRAM WHOSE ENROLLMENT DOES NOT EXCEED THE
FEDERAL OMIT OF 75% MEDICAID AND MEDICARE ENROLLEES, UNLESS AND UNTIL
THE 75% LIMIT IS REPEALED FROM FEDERAL LAW OR WAIVED BY THE HEALTH
CARE FINANCING ADMINISTRATION, AND IS:

(1)     A certified health maintenance organization THAT IS AUTHORIZED TO
RECEIVE MEDICAL ASSISTANCE PREPAID CAPITATION PAYMENTS, OR

(2)     A managed care system that is not a health maintenance organization
and does not hold a certificate of authority to operate as an insurer but is authorized
UNDER FEDERAL LAW OR WAIVER to receive MEDICAID prepaid capitation payments
AND IS subject to the regulatory solvency requirements, appropriate for the risk to be
assumed, adopted by the Insurance Commissioner in consultation with the Secretary; or.

(2) A CORPORATION THAT:

(I) IS A MANAGED CARE SYSTEM THAT IS AUTHORIZED TO RECEIVE
MEDICAL ASSISTANCE PREPAID CAPITATION PAYMENTS;

(II) ENROLLS ONLY PROGRAM RECIPIENTS; AND

(III) IS SUBJECT TO THE REQUIREMENTS OF § 15-1014 OF THIS TITLE.

(3)     A program that provides services to individuals under Title 7, Subtitle 3,
Title 7, Subtitle 7, § 8-204, Title 8, Subtitle 4, Title 10, Subtitle 9, or Title 10, Subtitle 12
of this article.

(G) "OMBUDSMAN PROGRAM" MEANS A PROGRAM THAT ASSISTS ENROLLEES
IN RESOLVING DISPUTES WITH MANAGED CARE ORGANIZATIONS IN A TIMELY
MANNER AND THAT IS RESPONSIBLE, AT A MINIMUM, FOR THE FOLLOWING
FUNCTIONS:

(1) INVESTIGATING DISPUTES BETWEEN ENROLLEES AND MANAGED
CARE ORGANIZATIONS REFERRED BY THE ENROLLEE HOTLINE;

(2) REPORTING TO THE DEPARTMENT:

- 2436 -