Ch. 352                                    1996 LAWS OF MARYLAND

(I) THE SECRETARY MAY EXCLUDE ALL DENTAL PROCEDURES
AND SERVICES FROM ANY PROGRAM DEVELOPED UNDER PARAGRAPH (1) OF THIS
SUBSECTION.

(II) THE SECRETARY MAY ESTABLISH A DENTAL MANAGED CARE
PROGRAM FOR ENROLLEES.

(ii) The Secretary may establish a managed care program for any
population or service excluded under subparagraph (i) of this paragraph.

(III) THE SECRETARY MAY ESTABLISH A MANAGED CARE
PROGRAM FOR PARTICIPANTS IN THE "PACE" PROJECT.

[(6)] (5) (10) (15) For a managed care [plan] ORGANIZATION with which
the Secretary contracts to provide services to Program recipients under this subsection,
the Secretary may require as a condition of that contract that the managed care [plan]
ORGANIZATION include SHALL INITIALLY ESTABLISH A MECHANISM TO INITIALLY
ASSURE THAT A EACH HISTORIC PROVIDER THAT MEETS THE DEPARTMENT'S
QUALITY STANDARDS HAS THE OPPORTUNITY TO CONTINUE TO SERVE PROGRAM
RECIPIENTS AS A SUBCONTRACTOR OF AT LEAST ONE MANAGED CARE
ORGANIZATION[, to the extent economically feasible, particular providers in providing
those services in the following circumstances:

(i) In areas that have been served historically by a community health
center, the Secretary may require a managed care plan to include that community health
center in its delivery of service to Program recipients who have traditionally obtained
health care services through that community health center;

(ii) For providers with residency programs for the training of health
care professionals, the Secretary may require a managed care plan to include those
providers in its delivery of service to Program recipients; and

(iii) In other circumstances to meet particular needs of Program
recipients or the community being served as provided in regulations adopted by the
Secretary.] PROVIDERS WHO HASTE HISTORICALLY SERVED PROGRAM RECIPIENTS,
IN ACCORDANCE WITH REGULATIONS ISSUED BY THE SECRETARY.

(11) THE DEPARTMENT SHALL MAKE CAPITATION PAYMENTS THAT ARE
ACTUARIALLY ADJUSTED TO:

(I) REFLECT THE RELATIVE RISK ASSUMED. AS DETERMINED BY
THE DEPARTMENT; AND

(II) ENCOURAGE MANAGED CARE ORGANIZATIONS TO DEVELOP
EXPERTISE IN TREATING SPECIAL NEEDS POPULATIONS.

(12) (I) A MANAGED CARE ORGANIZATION SHALL REPORT ANNUALLY
TO THE DEPARTMENT. AS THE DEPARTMENT PRESCRIBES. THE EXPENSE AND LOSS
RATIOS INCURRED BY THE MANAGED CARE ORGANIZATION IN DELIVERING
SERVICES TO ENROLLEES.

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