PARRIS N. GLENDENING, Governor

Ch. 503

19-710.

[(q) Notwithstanding any other provision of this section, a hospital emergency
facility may collect or attempt to collect payment from a subscriber or enrollee for health
care services provided to that subscriber or enrollee for a medical condition that is
determined not to be an emergency as defined in § 19-701 (d) of this subtitle.]

19-712.5.

(A)     A HEALTH MAINTENANCE ORGANIZATION SHALL REIMBURSE A
HOSPITAL EMERGENCY FACILITY AND PROVIDER, LESS ANY APPLICABLE
CO-PAYMENTS, FOR MEDICALLY NECESSARY SERVICES PROVIDED TO A MEMBER
OR SUBSCRIBER OF THE HEALTH MAINTENANCE ORGANIZATION IF THE HEALTH
MAINTENANCE ORGANIZATION AUTHORIZED, DIRECTED, REFERRED, OR
OTHERWISE ALLOWED THE MEMBER OR SUBSCRIBER TO USE THE EMERGENCY
FACILITY AND THE MEDICALLY NECESSARY SERVICES ARE RELATED TO THE
CONDITION FOR WHICH THE MEMBER WAS ALLOWED TO USE THE EMERGENCY
FACILITY.

(B)     A HEALTH MAINTENANCE ORGANIZATION SHALL REIMBURSE A
HOSPITAL EMERGENCY FACILITY AND PROVIDER, LESS ANY APPLICABLE
CO-PAYMENTS, FOR MEDICALLY NECESSARY SERVICES THAT RELATE TO THE
CONDITION PRESENTED AND THAT ARE PROVIDED BY THE PROVIDER IN THE
EMERGENCY FACILITY TO A MEMBER OR SUBSCRIBER OF THE HEALTH
MAINTENANCE ORGANIZATION IF THE HEALTH MAINTENANCE ORGANIZATION
FAILS TO PROVIDE 24-HOUR ACCESS IN ACCORDANCE WITH THE STANDARDS OF
QUALITY OF CARE REQUIRED UNDER § 19-705.1(B) (2) OF THIS SUBTITLE

SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read as
follows:

Article - Health - General

19-712.5.

(C)     A HEALTH MAINTENANCE ORGANIZATION SHALL REIMBURSE A
HOSPITAL EMERGENCY FACILITY AND PROVIDER. LESS ANY APPLICABLE
CO-PAYMENTS, FOR MEDICAL SCREENING SERVICES RENDERED TO MEET THE
REQUIREMENTS OF THE FEDERAL EMERGENCY MEDICAL TREATMENT AND ACTIVE
LABOR ACT.

SECTION 3. AND BE IT FURTHER ENACTED, That the Laws of Maryland read as
follows:

Article - Health - General

19-712.5.

(D)    NOTWITHSTANDING ANY OTHER PROVISION OF THIS SUBTITLE, A
PROVIDER MAY NOT BE REQUIRED TO OBTAIN PRIOR AUTHORIZATION OR
APPROVAL FOR PAYMENT FROM A HEALTH MAINTENANCE ORGANIZATION IN
ORDER TO OBTAIN REIMBURSEMENT UNDER SUBSECTION (A) OR (B) (A), (B), OR (C)
OF THIS SECTION.

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