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PARRIS N. GLENDENING, Governor
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Ch. 323
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(III) ANY OTHER FINANCIAL INFORMATION THE COMMISSIONER
REQUIRES FOR ADEQUATE FINANCIAL EVALUATION;
(2) COPIES OF DOWNSTREAM RISK ASSUMPTION CONTRACTS PROPOSED
TO BE MADE BETWEEN THE APPLICANT FOR LICENSURE AS A HEALTH SERVICES
CONTRACTOR AND A HEALTH MAINTENANCE ORGANIZATION; AND
(3) COPIES OF ADMINISTRATIS SERVICE PROVIDER CONTRACTS
PROPOSED TO BE MADE BETWEEN THE APPLICANT FOR LICENSURE AS A HEALTH
SERVICES CONTRACTOR AND A CONTRACTING PROVIDER
(B) AN APPLICANT FOR LICENSURE AS A HEALTH SERVICES CONTRACTOR
SHALL SATISFY TO THE COMMISSIONER THAT THE APPLICANT HAS A
DEMONSTRATED CAPACITY TO ASSUME FINANCIAL RISK UNDER THE PROPOSED
DOWNSTREAM RISK ASSUMPTION CONTRACT AND WILL MEET THE REQUIREMENTS
OF THIS SUBTITLE.
15-10D-05.
(A) THE COMMISSIONER SHALL ESTABLISH AND ADOPT BY REGULATION:
(1) MINIMUM CAPITAL AND SURPLUS REQUIREMENTS FOR LICENSED
HEALTH SERVICES CONTRACTORS; AND
(2) REQUIREMENTS THAT A LICENSED HEALTH SERVICES CONTRACTOR
MAINTAIN AN INSOLVENCY PLAN APPROVED BY THE COMMISSIONER.
(B) (1) THE COMMISSIONER SHALL ESTABLISH AND ADOPT BY REGULATION
REQUIREMENTS FOR THE CREATION AND MAINTENANCE, BY THE LICENSED HEALTH
SERVICES CONTRACTOR OR ON THE LICENSED HEALTH SERVICES CONTRACTOR'S
BEHALF, OF A SEGREGATED FUND OR THE AVAILABILITY OF OTHER RESOURCES.
(2) THE REGULATIONS SHALL:
(I) REQUIRE A SUFFICIENT AMOUNT TO BE HELD IN THE
SEGREGATED FUND TO SATISFY THE OBLIGATIONS OF THE LICENSED HEALTH
SERVICES CONTRACTOR TO EXTERNAL PROVIDERS FOR SERVICES RENDERED TO
MEMBERS OF THE HEALTH MAINTENANCE ORGANIZATION;
(II) SPECIFY THE METHODOLOGY FOR DETERMINING A
SUFFICIENT AMOUNT TO BE HELD IN THE SEGREGATED FUND;
(III) TO PROVIDE THAT THE SEGREGATED FUND MAY INCLUDE
WITHHELD FUNDS, ESCROW ACCOUNTS, LETTERS OF CREDIT, OR SIMILAR
ARRANGEMENTS;
(IV) REQUIRE AN ANNUAL REPORTING OF THE STATUS OF THE
SEGREGATED FUND; AND
(V) REQUIRE THAT ANY CHANGES MADE TO A DOWNSTREAM RISK
ASSUMPTION CONTRACT SHALL BE REVIEWED BY THE COMMISSIONER TO
DETERMINE THE SUFFICIENCY OF THE SEGREGATED FUND BASED ON THE CHANGES
MADE TO THE DOWNSTREAM RISK ASSUMPTION CONTRACT.
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- 1937 -
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