PARRIS N. GLENDENING, Governor

Ch. 14

2. The Program recipient initiates contact.

(16) (i) The Department shall be responsible for enrolling Program
recipients into managed care organizations.

(ii) The Department may contract with an entity to perform the
enrollment function.

(iii) The Department or its enrollment contractor shall administer a
health risk assessment developed by the Department to ensure that individuals who need
special or immediate health care services will receive the services on a timely basis.

(iv) The Department or its enrollment contractor:

1. May administer the health risk assessment only after the
Program recipient has chosen a managed care organization; and

2. Shall forward the results of the health risk assessment to the
managed care organization chosen by the Program recipient within 5 business days.

(17) For a managed care organization with which the Secretary contracts to
provide services to Program recipients under this subsection, the Secretary shall establish
a mechanism to initially assure that each historic provider that meets the Department's
quality standards has the opportunity to continue to serve Program recipients as a
subcontractor of at least one managed care organization.

(18) (i) The Department shall make capitation payments to each managed
care organization as provided in this paragraph.

(ii) In consultation with the Insurance Commissioner, the Secretary

shall:

1. Set capitation payments at a level that is actuarially adjusted
to the benefits provided; and

2. Actuarially adjust the capitation payments to reflect the
relative risk assumed by the managed care organization.

(19) (i) School-based clinics and managed care organizations shall
collaborate to provide continuity of care to enrollees.

(ii) School-based clinics shall be defined by the Department in
consultation with the State Department of Education.

(iii) Each managed care organization shall require a school-rbased
clinic to provide to the managed care organization certain information, as specified by the
Department, about an encounter with an enrollee of the managed care organization prior
to paying the school-based clinic.

(iv) Upon receipt of information specified by the Department, the
managed care organization shall pay, at Medicaid-established rates, school-based clinics
for covered services provided to enrollees of the managed care organization.

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