PARRIS N. GLENDENING, Governor

Ch. 161

THAT IS REGULATED UNDER ARTICLE 70B OF THE CODE AND RECEIVED HEALTH
CARE SERVICES IN AN ACUTE CARE HEALTH CARE FACILITY, THE RESIDENT'S
PRIMARY CARE PHYSICIAN SHALL REFER, IF MEDICALLY APPROPRIATE, THE
RESIDENT TO THE RESIDENT'S CONTINUING CARE FACILITY FOR THE PROVISION OF
HEALTH CARE SERVICES, AS PROVIDED IN THE RESIDENTS CONTINUING CARE
AGREEMENT, SKILLED NURSING UNIT AT THE RESIDENT'S CONTINUING CARE
FACILITY FOR THE PROVISION OF HEALTH CARE SERVICES INCLUDED IN THE
RESIDENTS HEALTH MAINTENANCE ORGANIZATION MEDICARE CONTRACT IF:

(1) THE PRIMARY CARE PHYSICIAN AND THE RESIDENT OR THE
DESIGNATED REPRESENTATIVE OF THE RESIDENT DO NOT CHOOSE AN
ALTERNATIVE COURSE OF TREATMENT;

(2) THE FACILITY AGREES TO BE REIMBURSED AT THE CONTRACT
RATE NEGOTIATED BY THE HEALTH MAINTENANCE ORGANIZATION WITH SIMILAR
PROVIDERS FOR THE PROVISION OF THE SAME HEALTH CARE SERVICES AND
SUPPLIES; AND

(2) THE CONTINUING CARE FACILITY BECOMES A CONTRACTING
PROVIDER IN ACCORDANCE WITH THE HEALTH MAINTENANCE ORGANIZATION'S
STANDARD TERMS AND CONDITIONS FOR ITS PARTICIPATING PROVIDERS AND
MEETS THE CREDENTIALING CRITERIA FOR BECOMING A PARTICIPATING
PROVIDER:

(3) THE CONTINUING CARE FACILITY MEETS ALL THE GUIDELINES
ESTABLISHED BY THE DIVISION OF LICENSING AND CERTIFICATION OF THE
DEPARTMENT, INCLUDING MEDICARE CERTIFICATION; AND

(4) THE CONTINUING CARE FACILITY'S SKILLED NURSING UNIT IS
CERTIFIED AS A MEDICARE SKILLED NURSING FACILITY;.

(5) (B) (1) THE CONTINUING CARE FACILITY IS NOT OBLIGATED TO
ACCEPT FOR THE PROVISION OF HEALTH CARE SERVICES ANYONE OTHER THAN A
RESIDENT OF THE CONTINUING CARE FACILITY; AND.

(6) NEITHER (2) THE HEALTH MAINTENANCE ORGANIZATION NOR AND
THE CONTINUING CARE FACILITY IS ARE NOT OBLIGATED TO ADVERTISE IN ANY
MANNER THAT THE CONTINUING CARE FACILITY IS A PARTICIPATING PROVIDER
WITH RESPECT TO COVERAGE OFFERED BY THE HEALTH MAINTENANCE
ORGANIZATION FOR MEDICARE BENEFITS OR OTHER TREATMENT IN THE SKILLED
NURSING FACILITY UNIT FOR ANYONE OTHER THAN RESIDENTS OF THE
CONTINUING CARE FACILITY.

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 1997.

Approved April 29, 1997.

- 1793 -