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Ch. 323
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2000 LAWS OF MARYLAND
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ESTABLISH AND MAINTAIN a segregated fund, IN A FORM AND AN AMOUNT
APPROVED BY THE COMMISSIONER, THAT IS:
(I) WHICH MAY INCLUDE WITHHELD FUNDS, ESCROW ACCOUNTS,
LETTERS OF CREDIT, OR SIMILAR ARRANGEMENTS, OR REQUIRE THE AVAILABILITY
OF OTHER RESOURCES THAT ARE (which may include withheld funds, escrow
accounts, letters of credit, or similar arrangements), or require the availability of
other resources that are sufficient to satisfy the contracting provider's obligations to
external providers for services rendered to members of the health maintenance
organization; AND
(II) EQUAL TO AT LEAST 3 MONTHS OF CAPITATION AND OTHER
PAYMENTS FOR HEALTH CARE SERVICES BY THE HEALTH MAINTENANCE
ORGANIZATION TO THE CONTRACTING PROVIDER:
(4) Require an explanation of how THE CONTRACTING PROVIDER TO
SUBMIT TO THE HEALTH MAINTENANCE ORGANIZATION INFORMATION
DEMONSTRATING THAT the fund or resources required ESTABLISHED under
paragraph ITEM (3) of this subsection create funds or other resources IS sufficient to
satisfy the contracting provider's obligations to external providers for services
rendered to members of the health maintenance organization; AND and
(5) Permit REQUIRE the health maintenance organization, at mutually
agreed upon times and upon reasonable prior notice AT LEAST QUARTERLY, to audit
REVIEW and inspect the contracting provider's books, records, and operations
relevant to the provider's contract for the purpose of determining the contracting
provider's compliance with the plan;.
(6) REQUIRE THE HEALTH MAINTENANCE ORGANIZATION TO INCLUDE
A COPY OF THE FINANCIAL STATEMENT REQUIRED UNDER ITEM (3) OF THIS
SUBSECTION IN ITS ANNUAL REPORT UNDER § 19-717 OF THIS SUBTITLE; AND
(7) REQUIRE THE CONTRACTING PROVIDER TO SUBMIT MONTHLY
REPORTS TO THE HEALTH MAINTENANCE ORGANIZATION ON THE STATUS OF THE
PAYMENTS MADE AND OWED TO EXTERNAL PROVIDERS AND THE COMPLIANCE BY
THE CONTRACTING PROVIDER WITH § 15-1995 OF THE INSURANCE ARTICLE.
(E) IN DETERMINING THE SUFFICIENCY OF A SEGREGATED FUND, THE
COMMISSIONER MAY CONSIDER WHETHER EXTERNAL PROVIDERS ARE OWNED OR
CONTROLLED BY THE CONTRACTING PROVIDER
(F) THE SEGREGATED FUND OR OTHER RESOURCES ESTABLISHED AS A
RESULT OF AN ADMINISTRATIVE SERVICE PROVIDER CONTRACT:
(1) SHALL BE HELD IN TRUST FOR PAYMENT TO EXTERNAL PROVIDERS;
AND
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(2) MAY NOT BE CONSIDERED AN ASSET OR AN ACCOUNT OF THE
CONTRACTING PROVIDER FOR THE PURPOSE OF DETERMINING THE ASSETS OR
ACCOUNTS OF A BANKRUPT CONTRACTING PROVIDER
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- 1926 -
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