|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
PARRIS N. GLENDENING, Governor Ch. 323
|
|
|
|
|
|
|
|
|
|
(d) (G) The health maintenance organization and the contracting provider
shall comply with the plan.
(E) (1) THE HEALTH MAINTENANCE ORGANIZATION SHALL FILE WITH THE
COMMISSIONER THE RESULTS OF EACH QUARTERLY AUDIT REQUIRED UNDER
SUBSECTION (C)(5) OF THIS SECTION?
(2) AT LEAST ANNUALLY, THE HEALTH MAINTENANCE ORGANIZATION
SHALL FILE THE FOLLOWING INFORMATION WITH THE COMMISSIONER IN A FORM
APPROVED BY THE COMMISSIONER-
(I) A COPY OR SUMMARY OF EACH ADMINISTRATIVE SERVICE
PROVIDER CONTRACT;
(II) DOCUMENTATION OF CAPITATION AND OTHER PAYMENTS
MADE UNDER EACH ADMINISTRATIVE SERVICE PROVIDER CONTRACT:
(III) THE NUMBER OF LIVES COVERED UNDER EACH
ADMINISTRATIVE SERVICE PROVIDER CONTRACT;
(IV) THE FUNDING AND STATUS OF EACH SEGREGATED FUND; AND
(V) ANY OTHER INFORMATION THE COMMISSIONER DETERMINES
TO BE APPROPRIATE.
(e) (F) (H) (1) The health maintenance organization shall monitor the
contracting provider to assure compliance with the plan, and the health maintenance
organization shall notify the contracting provider whenever a failure to comply with
the plan occurs.
(2) Upon the failure of the contracting provider to comply with the plan
following notice of noncompliance, or upon termination of the administrative service
provider contract for any reason, the health maintenance organization shall NOTIFY
THE COMMISSIONER AND SHALL assume the administration of any payments due
from the contracting provider to external providers on behalf of the contracting
provider, AS REQUIRED UNDER § 19-712 OF THIS SUBTITLE.
(I) THE HEALTH MAINTENANCE ORGANIZATION SHALL FILE WITH THE
COMMISSIONER THE RESULTS OF EACH QUARTERLY REVIEW REQUIRED UNDER
SUBSECTION (D)(5) OF THIS SECTION.
(f) (G) (J) The plan and all supporting documentation submitted in
connection with the plan shall be treated as confidential and proprietary, and may not
be disclosed except as otherwise required by law.
(g) (H) On July 1, 1901, any health maintenance organization which has
existing contracts or arrangements subject to this section shall file a plan under this
section within 120 days.]
(I) THE SEGREGATED FUND ESTABLISHED UNDER SUBSECTION (C) OF THIS
SECTION MAY NOT BE CONSIDERED AN ASSET OF A CONTRACTING PROVIDER FOR
THE PURPOSE OF DETERMINING THE ASSETS OF A CONTRACTING PROVIDER
|
|
|
|
|
|
|
|
|
|
- 1927 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
 |
