Ch. 245

1997 LAWS OF MARYLAND

Article - Insurance

15-604.

(A) 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.

15-606.

(A) IN THIS SECTION, "CARRIER" MEANS:
          (1) AN INSURER;

(2) A NONPPROFIT HEALTH SERVICE PLAN;
(3) A HEALTH MAINTENANCE ORGANIZATION;
(4) A DENTAL PLAN ORGANIZATION; OR

(5) ANY OTHER PERSON THAT PROVIDES HEALTH BENEFIT PLANS SUBJECT
TO REGULATION BY THE STATE.

(B) (1) THE HEALTH CARE ACCESS AND COST COMMISSION SHALL ADOPT
REGULATIONS THAT SPECIFY A PLAN FOR SUBSTANTIAL, AVAILABLE, AND
AFFORDABLE COVERAGE THAT SHALL BE OFFERED IN THE NONGROUP MARKET BY
A CARRIER AN ENTITY A CARRIER THAT QUALIFIES FOR AN APPROVED PURCHASER
DIFFERENTIAL UNDER REGULATIONS ADOPTED BY THE HEALTH SERVICES COST
REVIEW COMMISSION.

(2) IN ESTABLISHING A PLAN UNDER THIS SUBSECTION, THE HEALTH
CARE ACCESS AND COST COMMISSION SHALL JUDGE PREVENTIVE SERVICES,
MEDICAL TREATMENTS, PROCEDURES, AND RELATED HEALTH SERVICES BASED ON:

(I) THEIR EFFECTIVENESS IN IMPROVING THE HEALTH OF

INDIVIDUALS;

(II) THEIR IMPACT ON MAINTAINING AND IMPROVING HEALTH
AND ENCOURAGING CONSUMERS TO USE ONLY THE HEALTH CARE SERVICES THEY
NEED; AND

(III) THEIR IMPACT ON THE AFFORDABILITY OF HEALTH CARE

COVERAGE

(3) THE HEALTH CARE ACCESS AND COST COMMISSION MAY EXCLUDE
FROM THE PLAN:

(I) A HEALTH CARE SERVICE, BENEFIT, COVERAGE, OR
REIMBURSEMENT FOR COVERED HEALTH CARE SERVICES THAT IS REQUIRED
UNDER THIS ARTICLE OR THE HEALTH - GENERAL ARTICLE TO BE PROVIDED OR
OFFERED IN A HEALTH BENEFIT PLAN THAT IS ISSUED OR DELIVERED IN THE STATE
BY A CARRIER BY A CARRIER. OR

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