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PARRIS N. GLENDENING, Governor
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Ch. 323
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(C) THE COMMISSIONER SHALL ADOPT REGULATIONS THAT:
(1) REQUIRE THE SEGREGATED FUND TO CONTAIN A SUFFICIENT
AMOUNT TO SATISFY THE OBLIGATIONS OF THE CONTRACTING PROVIDER TO
EXTERNAL PROVIDERS FOR SERVICES RENDERED TO MEMBERS OF THE HEALTH
MAINTENANCE ORGANIZATION;
(2) SPECIFY THE METHODOLOGY FOR DETERMINING A SUFFICIENT
AMOUNT TO BE HELD IN THE SEGREGATED FUND;
(3) PROVIDE THAT THE SEGREGATED FUND MAY INCLUDE WITHHELD
FUNDS, ESCROW ACCOUNTS, LETTERS OF CREDIT, OR SIMILAR ARRANGEMENTS;
(4) REQUIRE AN ANNUAL REPORTING OF THE STATUS OF THE
SEGREGATED FUND; AND
(5) REQUIRE THAT ANY CHANGES MADE TO AN ADMINISTRATIVE
SERVICES PROVIDER CONTRACT SHALL BE REVIEWED BY THE COMMISSIONER TO
DETERMINE THE SUFFICIENCY OF THE SEGREGATED FUND BASED ON THE CHANGES
MADE TO THE ADMINISTRATIVE SERVICES PROVIDER CONTRACT.
(D) UPON THE BANKRUPTCY OR INSOLVENCY OF A CONTRACTING PROVIDER,
THE SEGREGATED FUND CREATED UNDER THE REGULATIONS REQUIRED UNDER
SUBSECTION (C) OF THIS SECTION SHALL BE THE RESPONSIBILITY OF THE HEALTH
MAINTENANCE ORGANIZATION OR THE LICENSED HEALTH SERVICES CONTRACTOR
AND SHALL BE USED FOR PAYMENTS OWED BY THE CONTRACTING PROVIDER TO
EXTERNAL PROVIDERS AND MAY NOT BE CONSIDERED TO BE AN ASSET OR ACCOUNT
OF THE CONTRACTING PROVIDER.
(E) THE HEALTH MAINTENANCE ORGANIZATION OR THE LICENSED HEALTH
SERVICES CONTRACTOR AND THE CONTRACTING PROVIDER SHALL COMPLY WITH
THE PLAN.
(F) THE HEALTH MAINTENANCE ORGANIZATION OR THE LICENSED HEALTH
SERVICES CONTRACTOR SHALL MONITOR THE CONTRACTING PROVIDER TO ASSURE
COMPLIANCE WITH THE PLAN, AND THE HEALTH MAINTENANCE ORGANIZATION OR
THE LICENSED HEALTH SERVICES CONTRACTOR SHALL NOTIFY THE CONTRACTING
PROVIDER WHENEVER A FAILURE TO COMPLY WITH THE PLAN OCCURS.
(G) (1) UPON THE FAILURE OF A CONTRACTING PROVIDER TO COMPLY
WITH THE PLAN FOLLOWING A NOTICE OF NONCOMPLIANCE, OR UPON A
TERMINATION OF THE ADMINISTRATIVE SERVICE PROVIDER CONTRACT FOR ANY
REASON, THE HEALTH MAINTENANCE ORGANIZATION OR LICENSED HEALTH
SERVICES CONTRACTOR SHALL;
(1) BE FINANCIALLY AND ADMINISTRATIVELY RESPONSIBLE FOR
PAYMENT DUE FROM THE CONTRACTING PROVIDER TO EXTERNAL PROVIDERS ON
BEHALF OF THE CONTRACTING PROVIDER; AND
(II) MAKE ALL PAYMENTS TO EXTERNAL PROVIDERS IN
ACCORDANCE WITH THE REQUIREMENTS OF § 15-1005 OF THIS TITLE.
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- 1941 -
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