PARRIS N. GLENDENING, Governor

Ch. 363

19-705.1.

(b) The standards of quality of care shall include:

(2) A requirement that a health maintenance organization shall have a
system for providing a member with 24-hour access to a physician in cases where there is
an immediate need for medical services, AND FOR PROMOTING TIMELY ACCESS TO
AND CONTINUITY OF HEALTH CARE SERVICES FOR MEMBERS, [including providing
INCLUDING:

(I) PROVIDING 24-hour access by telephone to a person who is able to
appropriately respond to calls from members and providers concerning after-hours care]
INCLUDING, AND:

(I) (II) PROVIDING A 24-HOUR TOLL FREE TELEPHONE ACCESS
SYSTEM FOR USE IN HOSPITAL EMERGENCY DEPARTMENTS-: IN ACCORDANCE WITH §
19-705.6 OF THIS SUBTITLE.

1. FOR MEMBERS AND PROVIDERS TO DETERMINE, WITH
ONE TELEPHONE CALL TO A CURRENT ROSTER, THE PRIMARY CARE PROVIDER
ASSIGNED TO A MEMBER; AND

2. FOR PROVIDERS TO DETERMINE, WITH ONE TELEPHONE
CALL TO A CURRENT ROSTER, EACH SPECIALTY PROVIDER CONTRACTED TO BE ON
CALL FOR EACH HEALTH MAINTENANCE ORGANIZATION AT EACH HOSPITAL IN THE
STATE FOR EACH DAY OF THE MONTH;

(II) PROVIDING AUTHORIZATION AT THE INITIAL TELEPHONE
ACCESS FOR MEMBERS WHO DO NOT HAVE AN ASSIGNED PRIMARY CARE
PROVIDER; AND

(III) PROVIDING FOR THE REIMBURSEMENT OF THE MEDICAL OR
SURGICAL PROVIDER ON CALL FOR UNASSIGNED PATIENTS GENERALLY OR THE
APPROPRIATE SPECIALIST ON CALL FOR THE HOSPITAL ON THAT DATE IN THE
EVENT A TELEPHONE ACCESS SYSTEM IS NOT ESTABLISHED, OR IF A MEMBER'S
PRIMARY CARE PROVIDER OR THE SPECIALIST NEEDED BY A MEMBER CANNOT BE
DETERMINED WITHIN A REASONABLE TIME, AS DETERMINED BY THE
CIRCUMSTANCES OF THE CASE IN THE JUDGMENT OF TILE TREATING EMERGENCY
PHYSICIAN, BUT NOT EXCEEDING 30 MINUTES AFTER THE INITIAL DOCUMENTED
CALL TO THE TELEPHONE ACCESS SYSTEM, WITH REIMBURSEMENT FOR
NONCONTRACTING PROVIDERS AS PROVIDED IN § 19-710.1 OF THIS SUBTITLE;

19-705.6.

(A) THE 24-HOUR TOLL FREE TELEPHONE ACCESS SYSTEM PROVIDED BY
EACH HEALTH MAINTENANCE ORGANIZATION SHALL

(1) ENABLE MEMBERS AND PROVIDERS TO DETERMINE, WITH ONE
TELEPHONE CALL THE PRIMARY CARE PROVIDER ASSIGNED TO A MEMBER;

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