PARRIS N. GLENDENING, Governor Ch. 14

3. Information from the local department of social services
regarding any other service or benefit the enrollee receives, including assistance or
benefits under Article 88A of the Code; and

4. Any information the managed care organization receives
from a school-based clinic, a core services agency, a local health department, or any other
person that has provided health services to the enrollee; and

(xv) Upon provision of information specified by the Department under
paragraph (19) of this subsection, pay school-based clinics for services provided to the
managed care organization's enrollees.

(10) The Department shall adopt regulations that assure that managed care
organizations employ appropriate personnel to:

(i) Assure that individuals with special needs obtain needed services;

and

(ii) Coordinate those services.

(11)  (i) A managed care organization shall reimburse a hospital emergency
facility and provider for:

1. Health care services that meet the definition of emergency
services in § 19-701 of this article;

2. Medical screening services rendered to meet the
requirements of the Federal Emergency Medical Treatment and Active Labor Act;

3. Medically necessary services if the managed care
organization authorized, referred, or otherwise allowed the enrollee to use the emergency
facility and the medically necessary services are related to the condition for which the
enrollee was allowed to use the emergency facility; and

4. Medically necessary services that relate to the condition
presented and that are provided by the provider in the emergency facility to the enrollee
if the managed care organization fails to provide 24-hour access to a physician as
required by the Department.

(ii) A provider may not be required to obtain prior authorization or
approval for payment from a managed care organization in order to obtain
reimbursement under this paragraph.

(12) (i) Each managed care organization shall notify each enrollee when
the enrollee should obtain an immunization, examination, or other wellness service.

(ii) Managed care organizations shall:

1. Maintain evidence of compliance with paragraph (9)(i) of

this subsection; and

2. Upon request by the Department, provide to the Department
evidence of compliance with paragraph (9)(i) of this subsection.

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