Ch. 352                                    1996 LAWS OF MARYLAND

C. WITHIN 270 DAYS OF THEIR ENROLLMENT MAY NOT RECEIVE
MORE THAN 50% OF ITS CAPITATION PAYMENTS.

(4) A MANAGED CARE ORGANIZATION MAY NOT DENY AN
APPLICATION FOR PARTICIPATION OR TERMINATE PARTICIPATION ON ITS
PROVIDER PANEL SOLELY ON THE BASIS OF THE LICENSE, CERTIFICATION. OR
OTHER AUTHORIZATION OF THE PROVIDER TO PROVIDE SERVICES IF THE
MANAGED CARE ORGANIZATION PROVIDES SERVICES WITHIN THE PROVIDER'S
LAWFUL SCOPE OF PRACTICE.

[(3) The Secretary shall ensure participation in the development of the
managed care program by the involvement of a broad-based steering committee including
legislative, consumer, and provider representation.

(4) The Secretary shall submit to the Senate Finance Committee and House
Environmental Matters Committee of the General Assembly for their review any
proposals developed under paragraph (1) of this subsection prior to requesting approval
by the U.S. Department of Health and Human Services under § 1115 of the Social
Security Act.]

(5) (11) THE DEPARTMENT SHALL:

(I) ESTABLISH AND MAINTAIN AN OMBUDSMAN PROGRAM AND A
LOCALLY ACCESSIBLE ENROLLEE HOTLINE;

(II) PERFORM FOCUSED MEDICAL REVIEWS OF MANAGED CARE
ORGANIZATIONS, INCLUDING REVIEWS OF SPECIAL POPULATIONS THAT INCLUDE
REVIEWS OF HOW THE MANAGED CARE ORGANIZATIONS ARE PROVIDING HEALTH CARE
SERVICES TO SPECIAL POPULATIONS

(III) PROVIDE TIMELY FEEDBACK TO EACH MANAGED CARE
ORGANIZATION ON ITS COMPLIANCE WITH THE DEPARTMENTS QUALITY ND ACCESS
SYSTEM;

(III) ESTABLISH (IV) ESTABLISH AND MAINTAIN WITHIN THE
DEPARTMENT A PROCESS FOR HANDLING PROVIDER COMPLAINTS ABOUT
MANAGED CARE ORGANIZATIONS; AND

(IV) (V) ADOPT REGULATIONS RELATING TO APPEALS BY
MANAGED CARE ORGANIZATIONS OF PENALTIES IMPOSED BY THE DEPARTMENT,
INCLUDING REGULATIONS PROVIDING FOR AN APPEAL TO THE OFFICE OF
ADMINISTRATIVE HEARINGS.

(6) (12) (I) EXCEPT AS PROVIDED IN SUBPARAGRAPH (III) OF THIS
PARAGRAPH. THE DEPARTMENT SHALL DELEGATE RESPONSIBILITY FOR
MAINTAINING THE OMBUDSMAN PROGRAM FOR A COUNTY TO THAT COUNTY'S
LOCAL HEALTH DEPARTMENT ON THE REQUEST OF THE LOCAL HEALTH
DEPARTMENT.

(II) A LOCAL HEALTH DEPARTMENT MAY NOT SUBCONTRACT THE
OMBUDSMAN PROGRAM

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