PARRIS N. GLENDENING, Governor

Ch. 352

(II) A PROVIDER MAY NOT BE REQUIRED TO OBTAIN PRIOR
AUTHORIZATION OR APPROVAL FOR PAYMENT FROM A MANAGED CARE ORGANIZATION
IN ORDER TO OBTAIN REIMBURSEMENT UNDER THIS PARAGRAPH.

(XIX) MAINTAIN AS PART OF THE ENROLLEE'S MEDICAL RECORD
THE FOLLOWING INFORMATION:

1. THE BASIC HEALTH RISK ASSESSMENT CONDUCTED ON
ENROLLMENT;

2. ANY INFORMATION THE MANAGED CARE
ORGANIZATION RECEIVES THAT RESULTS FROM AN ASSESSMENT OF THE
ENROLLEE CONDUCTED FOR THE PURPOSE OF ANY EARLY INTERVENTION,
EVALUATION, PLANNING, OR CASE MANAGEMENT PROGRAM;

3. INFORMATION FROM THE LOCAL DEPARTMENT OF
SOCIAL SERVICES REGARDING ANY OTHER SERVICE OR BENEFIT THE ENROLLEE
RECEIVES, INCLUDING ASSISTANCE OR BENEFITS UNDER ARTICLE 88A OF THE
CODE; AND

4. ANY INFORMATION THE MANAGED CARE
ORGANIZATION RECEIVES FROM A SCHOOL-BASED CLINIC, A CORE SERVICES
AGENCY, A LOCAL HEALTH DEPARTMENT, OR ANY OTHER PERSON THAT HAS
PROVIDED HEALTH SERVICES TO THE ENROLLEE; AND

(XX)  UPON PROVISION OF INFORMATION SPECIFIED BY THE
DEPARTMENT UNDER PARAGRAPH (13) OF THIS SUBSECTION, PAY SCHOOL-BASED
CLINICS FOR SERVICES PROVIDED TO THE MANAGED CARE ORGANIZATION'S
ENROLLEES.

(XXI) 1. EACH MANAGED CARE ORGANIZATION SHALL NOTIFY EACH
ENROLLEE WHEN THE ENROLLEE SHOULD OBTAIN AN IMMUNIZATION, EXAMINATION,
OR OTHER WELLNESS SERVICE

2. MANAGED CARE ORGANIZATIONS SHALL:

A. MAINTAIN EVIDENCE OF COMPLIANCE WITH
SUBPARAGRAPH (I) OF THIS PARAGRAPH; AND

B. UPON REQUEST BY THE DEPARTMENT, PROVIDE TO THE
DEPARTMENT EVIDENCE OF COMPLIANCE WITH SUBPARAGRAPH (I) OF THIS
PARAGRAPH.

3. A MANAGED CARE ORGANIZATION THAT DOES NOT COMPLY
WITH SUBPARAGRAPH I. IF THIS PARAGRAPH FOR AT LEAST 90% OF ITS NEW
ENROLLEES:

A. WITHIN 90 DAYS OF THEIR ENROLLMENT MAY NOT RECEIVE
MORE THAN 80% OF ITS CAPITATION PAYMENTS;

B. WITHIN 180 DAYS OF THEIR ENROLLMENT MAY NOT RECEIVE
MORE THAN 70% OF ITS CAPITATION PAYMENTS; AND

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