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Ch. 275
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PARRIS N. GLENDENING, Governor
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(F) IF THE HEALTH MAINTENANCE ORGANIZATION PAYS A CLAIM FOR A
HEALTH CARE SERVICE FOR WHICH THE SUBSCRIBER OR ENROLLEE HAS PRIVATELY
CONTRACTED WITH A HEALTH CARE PROVIDER UNDER SUBSECTION (D) OF THIS
SECTION, THE PATIENT OR HEALTH CARE PROVIDER MAY ACCEPT PAYMENT
WITHOUT AFFECTING THE PRIVATE CONTRACT.
(G) (D) (1) A HEALTH CARE PROVIDER MAY ENFORCE THE PROVISIONS OF
THIS SECTION BY FILING A COMPLAINT AGAINST A HEALTH MAINTENANCE
ORGANIZATION WITH THE MARYLAND INSURANCE ADMINISTRATION OR BY FILING A
CIVIL ACTION IN A COURT OF COMPETENT JURISDICTION UNDER § 1-501 OR § 4-201
OF THE COURTS ARTICLE.
(2) THE MARYLAND INSURANCE ADMINISTRATION OR A COURT SHALL
AWARD REASONABLE ATTORNEY FEES IF THE COMPLAINT OF THE HEALTH CARE
PROVIDER IS SUSTAINED.
[(d)] (H) (E) In addition to any other penalties under this subtitle, the
Commissioner may impose a penalty not to exceed $5,000 on any health maintenance
organization which violates the provisions of this section if the violation is committed
with such frequency as to indicate a general business practice of the health
maintenance organization.
SECTION 3. AND BE IT FURTHER ENACTED, That the Health Services
Cost Review Commission, in consultation with the Maryland Health Care
Commission, the Maryland Insurance Administration, health care providers, and
health maintenance organizations, shall develop a methodology for ensuring
reasonable payment to health care providers not under written contract with a health
maintenance organization. The Commission shall report its findings and
recommendations to the House Economic Matters Committee and the Senate Finance
Committee, in accordance with § 2-1246 of the State Government Article, on or before
January 1, 2002.
SECTION 4. AND BE IT FURTHER ENACTED, That this Act applies to health
care services rendered on or after October 1, 2000.
SECTION 4t 5. AND BE IT FURTHER ENACTED, That Section 2 Sections 2
and 4 of this Act shall take effect October 1, 2000. Section 2 Sections 2 and 4 of this
Act shall remain effective for a period of 1 year and 9 months and, at the end of June
30, 2002, with no further action required by the General Assembly, Section 2 Sections
2 and 4 of this Act shall be abrogated and of no further force and effect.
SECTION £ AND BE IT FURTHER ENACTED, That, subject to Section 4
5 of this Act, this Act shall take effect October 1, 2000.
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Approved May 11, 2000.
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- 1637 -
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