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2000 LAWS OF MARYLAND
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Ch. 323
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(ii) in the aggregate for health benefit plans that are issued to
individuals;
(iii) in the aggregate for a managed care organization that operates
under Title 15, Subtitle 1 of the Health - General Article; and
(iv) in a manner determined by the Commissioner in accordance
with this subsection for all other health benefit plans.
(4) THE COMMISSIONER, IN CONSULTATION WITH THE SECRETARY OF
HEALTH AND MENTAL HYGIENE, SHALL ESTABLISH AND ADOPT BY REGULATION A
METHODOLOGY TO BE UTILIZED USED IN THE ANNUAL REPORT THAT ENSURES A
CLEAR SEPARATION OF ALL MEDICAL AND ADMINISTRATIVE EXPENSES WHETHER
INCURRED DIRECTLY OR THROUGH A SUBCONTRACTOR
(5) The Commissioner may conduct an examination to ensure that an
annual report submitted under this subsection is accurate.
[(5)] (6) Failure of an insurer, nonprofit health service plan, or health
maintenance organization to submit the information required under this subsection
in a timely manner shall result in a penalty of $500 for each day after March 1 that
the information is not submitted.
SUBTITLE 10D. REGULATION OF ADMINISTRATIVE SERVICE PROVIDER CONTRACTS
AND DOWNSTREAM RISK ASSUMPTION CONTRACTS.
15-10D-01.
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS
INDICATED.
(B) "ADMINISTRATIVE SERVICE PROVIDER CONTRACT" MEANS A CONTRACT
OR CAPITATION AGREEMENT BETWEEN A HEALTH MAINTENANCE ORGANIZATION
AND A CONTRACTING PROVIDER OR BETWEEN A LICENSED HEALTH SERVICES
CONTRACTOR AND A CONTRACTING PROVIDER THAT INCLUDES REQUIREMENTS
THAT:
(1) THE CONTRACTING PROVIDER ACCEPT PAYMENTS FROM A HEALTH
MAINTENANCE ORGANIZATION FOR HEALTH CARE SERVICES TO BE PROVIDED TO
MEMBERS OF A HEALTH MAINTENANCE ORGANIZATION THAT THE CONTRACTING
PROVIDER ARRANGES TO BE PROVIDED BY EXTERNAL PROVIDERS; AND
(2) THE CONTRACTING PROVIDER ADMINISTER PAYMENTS PURSUANT
TO THE CONTRACT WITHIN THE HEALTH MAINTENANCE ORGANIZATION FOR THE
HEALTH CARE SERVICES TO THE EXTERNAL PROVIDERS.
(C) "CAPITATED BASIS" MEANS A FIXED MEMBER PER MONTH PAYMENT OR
FIXED PERCENTAGE OF PREMIUM PAYMENT WHERE THE PROVIDER OR
CONTRACTING PROVIDER ASSUMES THE RISK FOR THE COST OF THE CONTRACTED
HEALTH CARE SERVICE.
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- 1934 -
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