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Ch. 323
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2000 LAWS OF MARYLAND
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(1) § 9-231 OF THIS ARTICLE REGARDING NOTICE OF IMPAIRMENT OF AN
INSURER AND PROHIBITION ON CONTRIBUTION TO IMPAIRMENT OF AN INSURER;
AND
(2) TITLE 9, SUBTITLE 1 OF THIS ARTICLE REGARDING IMPAIRED
ENTITIES.
15-10D-08.
(A) A HEALTH MAINTENANCE ORGANIZATION OR A LICENSED HEALTH
SERVICES CONTRACTOR MAY NOT ENTER INTO AN ADMINISTRATIVE SERVICE
PROVIDER CONTRACT WITH A CONTRACTING PROVIDER UNLESS:
(1) THE HEALTH MAINTENANCE ORGANIZATION OR THE LICENSED
HEALTH SERVICES CONTRACTOR FILES WITH THE COMMISSIONER A PLAN THAT
SATISFIES THE REQUIREMENTS OF SUBSECTION (B) OF THIS SECTION; AND
(2) THE COMMISSIONER DOES NOT DISAPPROVE THE FILING WITHIN 30
DAYS AFTER THE PLAN IS FILED.
(B) THE PLAN REQUIRED UNDER SUBSECTION (A) OF THIS SECTION SHALL;
(1) REQUIRE THE CONTRACTING PROVIDER TO PROVIDE THE HEALTH
MAINTENANCE ORGANIZATION OR THE LICENSED HEALTH SERVICES CONTRACTOR
WITH REGULAR REPORTS, AT LEAST QUARTERLY, THAT IDENTIFY PAYMENTS MADE
OR OWED TO EXTERNAL PROVIDERS IN SUFFICIENT DETAIL TO DETERMINE IF THE
PAYMENTS ARE BEING MADE IN COMPLIANCE WITH LAW;
(2) REQUIRE THE CONTRACTING PROVIDER TO PROVIDE TO THE
HEALTH MAINTENANCE ORGANIZATION OR THE LICENSED HEALTH SERVICES
CONTRACTOR A CURRENT ANNUAL FINANCIAL STATEMENT OF THE CONTRACTING
PROVIDER EACH YEAR;
(3) REQUIRE THE CREATION AND MAINTENANCE BY THE CONTRACTING
PROVIDER, OR ON THE CONTRACTING PROVIDER'S BEHALF, OF A SEGREGATED FUND
IN COMPLIANCE WITH THE REGULATIONS ADOPTED BY THE COMMISSIONER;
(4) REQUIRE AN EXPLANATION OF HOW THE FUND OR RESOURCES
REQUIRED UNDER ITEM (3) OF THIS SUBSECTION CREATE FUNDS OR OTHER
RESOURCES SUFFICIENT TO SATISFY THE CONTRACTING PROVIDER'S OBLIGATIONS
TO EXTERNAL PROVIDERS FOR SERVICES RENDERED TO MEMBERS OF THE HEALTH
MAINTENANCE ORGANIZATION;
(5) REQUIRE THE CONTRACTING PROVIDER TO COMPLY WITH THE
PROVISIONS OF §§ 15-1005 AND 15-1008 OF THIS TITLE; AND
(6) PERMIT THE HEALTH MAINTENANCE ORGANIZATION OR LICENSED
HEALTH SERVICES CONTRACTOR, AT MUTUALLY AGREED UPON TIMES AND UPON
REASONABLE PRIOR NOTICE, TO AUDIT 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.
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- 1940 -
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