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Ch. 323
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2000 LAWS OF MARYLAND
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(C) UPON THE BANKRUPTCY OR INSOLVENCY OF A LICENSED HEALTH
SERVICES CONTRACTOR, THE SEGREGATED FUND CREATED UNDER THE
REGULATIONS REQUIRED UNDER SUBSECTION (B) OF THIS SECTION SHALL BE THE
RESPONSIBILITY OF THE HEALTH MAINTENANCE ORGANIZATION AND SHALL BE
USED FOR PAYMENTS OWED BY THE LICENSED HEALTH SERVICES CONTRACTOR TO
EXTERNAL PROVIDERS AND MAY NOT BE CONSIDERED TO BE AN ASSET OR ACCOUNT
OF THE LICENSED HEALTH SERVICES CONTRACTOR,
(D) THE COMMISSIONER MAY REQUIRE THAT A HEALTH MAINTENANCE
ORGANIZATION AND A LICENSED HEALTH SERVICES CONTRACTOR, PRIOR TO
ENTERING INTO A DOWNSTREAM RISK ASSUMPTION CONTRACT, FILE AND RECEIVE
APPROVAL FROM THE COMMISSIONER OF A PLAN THAT SATISFIES ANY OF THE
REQUIREMENTS OF A PLAN TO BE FILED UNDER § 15-10D-08 OF THIS SUBTITLE.
(E) A LICENSED HEALTH SERVICES CONTRACTOR SHALL COMPLY WITH THE
PROVISIONS OF §§ 15-1005 AND 15-1008 OF THIS TITLE AS TO THE CLAIMS OF
EXTERNAL PROVIDERS.
(F) (1) UPON THE FAILURE OF A LICENSED HEALTH SERVICES
CONTRACTOR TO COMPLY WITH THE REQUIREMENTS OF THIS SUBTITLE OR UPON
THE TERMINATION OF THE DOWNSTREAM RISK ASSUMPTION CONTRACT FOR ANY
REASON, THE HEALTH MAINTENANCE ORGANIZATION SHALL:
(I) BE FINANCIALLY AND ADMINISTRATIVELY RESPONSIBLE FOR
PAYMENT DUE FROM THE LICENSED HEALTH CARE SERVICES CONTRACTOR TO
EXTERNAL PROVIDERS ON BEHALF OF THE LICENSED HEALTH CARE SERVICES
CONTRACTOR; AND
(II) MAKE ALL PAYMENTS TO EXTERNAL PROVIDERS IN
ACCORDANCE WITH THE REQUIREMENTS OF § 15-1005 OF THIS TITLE.
(2) A HEALTH MAINTENANCE ORGANIZATION SHALL MEET THE
REQUIREMENTS OF THIS SUBSECTION, REGARDLESS OF THE EXISTENCE OF THE
SEGREGATED FUND OR A CONTRARY PROVISION IN A DOWNSTREAM RISK
ASSUMPTION CONTRACT.
(3) NOTHING IN PARAGRAPH (1) OR (2) OF THIS SUBSECTION MAY BE
CONSTRUED TO PROHIBIT A HEALTH MAINTENANCE ORGANIZATION FROM SEEKING
PAYMENT FROM A LICENSED HEALTH SERVICES CONTRACTOR OR FROM AMOUNTS
HELD IN THE SEGREGATED FUND FOR PAYMENTS MADE TO EXTERNAL PROVIDERS
ON BEHALF OF THE LICENSED HEALTH SERVICES CONTRACTOR
(G) EXCEPT AS OTHERWISE PROVIDED BY LAW, INDIVIDUAL MEMBERS AND
SUBSCRIBERS OF HEALTH MAINTENANCE ORGANIZATIONS SHALL NOT BE LIABLE TO
A LICENSED HEALTH SERVICES CONTRACTOR FOR ANY COVERED SERVICES
PROVIDED TO THE ENROLLEE OR SUBSCRIBER
15-10D-06.
(A) UNLESS, FOR GOOD CAUSE SHOWN, THE COMMISSIONER EXTENDS THE
TIME FOR A REASONABLE PERIOD.
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- 1938 -
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