Ch. 352

1996 LAWS OF MARYLAND

(XIV) PROVIDE OR ARRANGE TO PROVIDE ALL
MEDICAID-COVERED SERVICES REQUIRED TO COMPLY WITH STATE STATUTES AND
REGULATIONS MANDATING HEALTH AND MENTAL HEALTH SERVICES FOR
CHILDREN IN STATE SUPERVISED CARE:

1.       ACCORDING TO STANDARDS SET BY THE DEPARTMENT;
AND

2. LOCALLY, TO THE EXTENT THE SERVICES ARE
AVAILABLE LOCALLY;

(XV) MAKE AVAILABLE TO ITS ENROLLEES THE DEPARTMENT'S
SUMMARY OF THE QUALITY ASSURANCE PROGRAM REQUIREMENTS:

(XVI) SUBMIT TO THE DEPARTMENT AGGREGATE INFORMATION
FROM THE QUALITY ASSURANCE PROGRAM, INCLUDING COMPLAINTS AND
RESOLUTIONS FROM THE ENROLLEE AND PROVIDER GRIEVANCE SYSTEM AND
HOTLINE, AND SYSTEMS, THE ENROLLEE HOTLINE, AND ENROLLEE SATISFACTION
SURVEYS;

(XVII) INITIALLY PROVIDE, AT A MINIMUM, THE SAME SERVICE
LEVEL THAT WAS CONTRACTUALLY REQUIRED TO BE PROVIDED BY MANAGED
CARE ORGANIZATIONS TO MEDICAID ENROLLEES AS OF JANUARY 1, 1996:

(XVIII) REIMBURSE FOR THE FOLLOWING HEALTH CARE SERVICES
PROVIDED, WITHOUT PRIOR APPROVAL FROM THE MANAGED CARE
ORGANIZATION, TO AN ENROLLEE IN A HOSPITAL EMERGENCY FACILITY:

(10) (I) A MANAGED CARE ORGANIZATION SHALL REIMBURSE A
HOSPITAL EMERGENCY FACILITY AND PROVIDER FOR

1. HEALTH CARE SERVICES THAT MEET THE DEFINITION OF
EMERGENCY SERVICES IN § 19-701 OF THIS ARTICLE;

2.       MEDICAL SCREENING SERVICES RENDERED TO MEET
THE REQUIREMENTS OF THE FEDERAL EMERGENCY MEDICAL TREATMENT AND
ACTIVE LABOR ACT;

3.       MEDICALLY NECESSARY SERVICES IF THE MANAGED
CARE ORGANIZATION AUTHORIZED, REFERRED, OR OTHERWISE ALLOWED THE
ENROLLEE TO USE THE EMERGENCY FACILITY AND THE MEDICALLY NECESSARY
SERVICES ARE RELATED TO THE CONDITION FOR WHICH THE ENROLLEE WAS
ALLOWED TO USE THE EMERGENCY FACILITY; AND

4.       MEDICALLY NECESSARY SERVICES THAT RELATE TO THE
CONDITION PRESENTED AND THAT ARE PROVIDED BY THE PROVIDER IN THE
EMERGENCY FACILITY TO THE ENROLLEE IF THE MANAGED CARE ORGANIZATION
FAILS TO PROVIDE 24-HOUR ACCESS TO A PHYSICIAN AS REQUIRED IN THE
DEPARTMENTS REGULATIONS; BY THE DEPARTMENT

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