PARRIS N. GLENDENING, Governor                                 Ch. 352

B. TRAINING AND CLINICAL GUIDANCE IN APPROPRIATE USE
OF THE DELIVERY SYSTEM FOR MANAGED CARE ORGANIZATION PRIMARY CARE
PROVIDERS;

C. PREAUTHORIZATION BY THE UTILIZATION REVIEW AGENT
OF THE DELIVERY SYSTEM; AND

D. PENALTIES FOR A PATTERN OF IMPROPER REFERRALS.

(III)    THE DEPARTMENT SHALL COLLABORATE WITH MANAGED CARE
ORGANIZATIONS TO DEVELOP STANDARDS AND GUIDELINES FOR THE PROVISION OF
SPECIALTY MENTAL HEALTH SERVICES.

(IV)    THE DELIVERY SYSTEM SHALL-

1. PROVIDE ALL SPECIALTY MENTAL HEALTH SERVICES
NEEDED BY ENROLLEES;

2. FOR ENROLLEES WHO ARE DUALLY-DIAGNOSED,
COORDINATE THE PROVISION OF SUBSTANCE ABUSE SERVICES PROVIDED BY THE
MANAGED CARE ORGANIZATIONS OF THE ENROLLEES;

3. CONSIST OF A NETWORK OF QUALIFIED MENTAL HEALTH
PROFESSIONALS FROM ALL CORE DISCIPLINES;

4. INCLUDE LINKAGES WITH OTHER PUBLIC SERVICE SYSTEMS;
AND

5. COMPLY WITH QUALITY ASSURANCE ENROLLEE INPUT,
DATA COLLECTION. AND OTHER REQUIREMENTS SPECIFIED BY THE DEPARTMENT IN
REGULATION.

(V) THE DEPARTMENT MAY CONTRACT WITH A MANAGED CARE
ORGANIZATION FOR DELIVERY OF SPECIALTY MENTAL HEALTH SERVICES IF THE
MANAGED CARE ORGANIZATION MEETS THE PERFORMANCE STANDARDS ADOPTED BY
THE DEPARTMENT IN REGULATIONS.

(16)    THE DEPARTMENT SHALL INCLUDE A DEFINITION OF MEDICAL
NECESSITY IN ITS QUALITY AND ACCESS STANDARDS.

(17)    (I) THE DEPARTMENT SHALL ADOPT REGULATIONS RELATING TO
ENROLLMENT, DISENROLLMENT, AND ENROLLEE APPEALS.

(II) THE REGULATIONS SHALL PERMIT AN ENROLLEE TO
DISENROLL WITHOUT CAUSE FROM A MANAGED CARE ORGANIZATION IN THE
MONTH FOLLOWING THE ANNIVERSARY DATE OF THE ENROLLEE'S ENROLLMENT.

(III) AN ENROLLEE MAY DISENROLL FROM A MANAGED CARE
ORGANIZATION FOR CAUSE.

(II) AN ENROLLEE MAY DISENROLL FROM A MANAGED CARE
ORGANIZATION;

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