Ch. 35

1997 LAWS OF MARYLAND

In subsection (b)(1) of this section, the reference to services paid for or
provided "by the Department" is added for clarity.

In subsection (b)(2) of this section, the reference to the terms "and
conditions" of the policy or contract is added for consistency with subsection
(b)(1) of this section.

In subsection (c) of this section, the reference to the date of "the service" is
substituted for the former references to the date of "treatment" for
consistency within this section.

Also in subsection (c) of this section, the former references to "deny[ing]"
reimbursement are deleted as included in the reference to "refus[ing]"
reimbursement.

Defined terms: "Health insurance" § 1-101
"Insurer" § 1-101
"Policy" § 1-101

15-604. RATES FOR PAYMENTS TO HOSPITALS.

EACH AUTHORIZED INSURER, NONPROFIT HEALTH SERVICE PLAN, AND
FRATERNAL BENEFIT SOCIETY, AND EACH MANAGED CARE ORGANIZATION THAT IS
AUTHORIZED TO RECEIVE MEDICAID PREPAID CAPITATION PAYMENTS UNDER
TITLE 15, SUBTITLE 1 OF THE HEALTH - GENERAL ARTICLE, SHALL PAY HOSPITALS
FOR HOSPITAL SERVICES RENDERED ON THE BASIS OF THE RATE APPROVED BY
THE HEALTH SERVICES COST REVIEW COMMISSION.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, § 490S(a).

The former reference to authorized insurers as "including" nonprofit health
service plans, fraternal benefit societies, and managed care organizations is
deleted since nonprofit health service plans, fraternal benefit societies, and
managed care organizations are not considered to be insurers.

Defined term: "Authorized insurer" § 1-101

15-605. RATES FOR HEALTH BENEFIT PLANS.

(A) ANNUAL REPORT REQUIRED.

(1) ON OR BEFORE MARCH 1 OF EACH YEAR, AN ANNUAL REPORT THAT
MEETS THE SPECIFICATIONS OF PARAGRAPH (2) OF THIS SUBSECTION SHALL BE
SUBMITTED TO THE COMMISSIONER BY:

(I) EACH AUTHORIZED INSURER THAT PROVIDES HEALTH
INSURANCE IN THE STATE;

(II) EACH NONPROFIT HEALTH SERVICE PLAN THAT IS
AUTHORIZED BY THE COMMISSIONER TO OPERATE IN THE STATE;

(III) EACH HEALTH MAINTENANCE ORGANIZATION THAT IS
AUTHORIZED BY THE COMMISSIONER TO OPERATE IN THE STATE; AND

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