Ch. 503                                    1996 LAWS OF MARYLAND

1.       Develop and publicize procedures to assure that the health
maintenance organization is notified of the services and receives adequate documentation
of the services;

2.       Develop and provide informational materials to all
subscribers and enrollees of the health maintenance organization that clearly describe
and inform subscribers and enrollees of their potential responsibility for payment for
services rendered by a health care provider, including a physician or hospital, that does
not have a written contract with the health maintenance organization; and

3.       Develop and provide specific information to all subscribers
and enrollees of the health maintenance organization that clearly describes the
procedures to be followed for emergency services, including:

A.      The appropriate use of hospital emergency rooms;

B.      The appropriate use, location, and hours of operation of any
urgent care facilities operated by the health maintenance organization; and

C.      The potential responsibility of subscribers and enrollees for
payment for emergency services or nonemergency, services rendered in a hospital
emergency facility pursuant to § 19-710(q) of this subtitle;]

(3) A REQUIREMENT THAT A HEALTH MAINTENANCE ORGANIZATION
HAVE PROCEDURES TO ASSURE THAT IT IS NOTIFIED OF SERVICES RENDERED TO A
MEMBER BY A PROVIDER THAT DOES NOT HAVE A CONTRACT WITH THE HEALTH

MAINTENANCE ORGANIZATION AND THAT IF OBTAINS ADEQUATE

DOCUMENTATION OF THE MEDICAL COMPLAINT OF THE MEMBER AND THE
SERVICES RENDERED;

(3) A REQUIREMENT THAT ANY NONPARTICIPATING PROVIDER SHALL
SUBMIT TO THE HEALTH MAINTENANCE ORGANIZATION THE APPROPRIATE
DOCUMENTATION OF THE MEDICAL COMPLAINT OF THE MEMBER AND THE SERVICES
RENDERED;

[(3)] (4) A requirement that a health maintenance organization shall have a
physician available at all times to provide diagnostic and treatment services;

[(4)] (5) A requirement that a health maintenance organization shall assure
that:

(i) Each member who is seen for a medical complaint is evaluated
under the direction of a physician; and

(ii) Each member who receives diagnostic evaluation or treatment is
under the direct medical management of a health maintenance organization physician
who provides continuing medical management; and

[(5)](6) A requirement that each member shall have an opportunity to
select a primary physician from among those available to the health maintenance
organization.

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