PARRIS N. GLENDENING, Governor                                 Ch. 352

PARAGRAPH (1) OF THIS SUBSECTION MAY PROVIDE GUARANTEED ELIGIBILITY FOR
EACH ENROLLEE FOR UP TO 6 MONTHS UNLESS AN ENROLLEE OBTAINS HEALTH
INSURANCE THROUGH ANOTHER SOURCE.

(4) (I) THE SECRETARY MAY EXCLUDE SPECIFIC POPULATIONS OR
SERVICES FROM THE PROGRAM DEVELOPED UNDER PARAGRAPH (1) OF THIS
SUBSECTION.

(II) FOR ANY POPULATIONS OR SERVICES EXCLUDED UNDER THIS
PARAGRAPH THE SECRETARY MAY AUTHORIZE A MANAGED CARE ORGANIZATION TO
PROVIDE THE SERVICES OR PROVIDE FOR THE POPULATION INCLUDING
AUTHORIZATION OF A SEPARATE DENTAL MANAGED CARE ORGANIZATION OR A
MANAGED CARE ORGANIZATION TO PROVIDE SERVICES TO PROGRAM RECIPIENTS WITH
SPECIAL NEEDS

(5) (I) EXCEPT FOR A SERVICE EXCLUDED BY THE SECRETARY UNDER
PARAGRAPH (4) OF THIS SUBSECTION, EACH MANAGED CARE ORGANIZATION SHALL
PROVIDE ALL THE BENEFITS REQUIRED BY REGULATIONS ADOPTED UNDER PARAGRAPH
(2) OF THIS SUBSECTION.

(II)     FOR A POPULATION OR SERVICE EXCLUDED BY THE SECRETARY
UNDER PARAGRAPH (4) OF THIS SUBSECTION THE SECRETARY MAY AUTHORIZE A
MANAGED CARE ORGANIZATION TO PROVIDE ONLY FOR THAT POPULATION OR PROVIDE
ONLY THAT SERVICE.

(III)   A MANAGED CARE ORGANIZATION MAY SUBCONTRACT SPECIFIED
REQUIRED SERVICES TO A HEALTH CARE PROVIDER THAT IS LICENSED OR AUTHORIZED
TO PROVIDE THOSE SERVICES.

(6) EXCEPT FOR THE PROGRAM OF ALL-INCLUSIVE CARE FOR THE
ELDERLY ("PACE") PROGRAM THE SECRETARY MAY NOT INCLUDE THE LONG-TERM
CARE POPULATION OR LONG-TERM CARE SERVICES IN THE PROGRAM DEVELOPED
UNDER PARAGRAPH (I) OF THIS SUBSECTION.

(7) THE PROGRAM DEVELOPED UNDER PARAGRAPH (1) OF THIS
SUBSECTION SHALL ENSURE THAT ENROLLEES HAVE ACCESS TO A PHARMACY THAT:

(I) IS LICENSED IN THE STATE: AND

(II) IS WITHIN A REASONABLE DISTANCE FROM THE ENROLLEES
RESIDENCE

(8) FOR CAUSE THE DEPARTMENT MAY DISENROLL ENROLLEES FROM A
MANAGED CARE ORGANIZATION AND ENROLL THEM IN ANOTHER MANAGED CARE
ORGANIZATION

(2) A managed care [plan] ORGANIZATION shall:

(3) (9) IF A MANAGED CARE ORGANIZATION AGREES TO
PARTICIPATE IN THE PROGRAM, THE EACH MANAGED CARE ORGANIZATION SHALL:

(i) Have a quality assurance program in effect which is subject to the
approval of the Department AND WHICH, AT A MINIMUM:

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