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S.B. 359
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VETOES
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Article - Health - General
Section 15-103(f)
Annotated Code of Maryland
(1994 Replacement Volume and 1999 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:
Article - Health - General
15-102.5.
(a) [A] SUBJECT TO § 15-103(F) OF THIS SUBTITLE, A health maintenance
organization that requires its panel providers to participate in a managed care
organization shall establish a mechanism, subject to review by the Secretary, which
provides for equitable distribution of enrollees and which ensures that a provider will
not be assigned a disproportionate number of enrollees.
(b) Nothing in this section may be interpreted as prohibiting a provider from
voluntarily accepting additional enrollees.
15-103.
(b) (23) (i) The Department shall adopt regulations relating to enrollment,
disenrollment, and enrollee appeals.
(ii) [An] SUBJECT TO SUBSECTION (F)(4) AND (5) OF THIS SECTION,
AN enrollee may disenroll from a managed care organization:
1. Without cause in the month following the anniversary
date of the enrollee's enrollment; and
2. For cause, at any time as determined by the Secretary.
(F) (1) THE DEPARTMENT SHALL ESTABLISH MECHANISMS FOR:
(I) IDENTIFYING A PROGRAM RECIPIENT'S PRIMARY CARE
PROVIDER AT THE TIME OF ENROLLMENT INTO A MANAGED CARE PROGRAM; AND
(II) MAINTAINING CONTINUITY OF CARE WITH THE PRIMARY CARE
PROVIDER IF:
1. THE PROVIDER HAS A CONTRACT WITH A MANAGED CARE
ORGANIZATION OR A CONTRACTED MEDICAL GROUP OF A MANAGED CARE
ORGANIZATION TO PROVIDE PRIMARY CARE SERVICES; AND
2. THE RECIPIENT DESIRES TO CONTINUE CARE WITH THE
PROVIDER
(2) IF A PROGRAM RECIPIENT ENROLLS IN A MANAGED CARE
ORGANIZATION AND REQUESTS ASSIGNMENT TO A PARTICULAR PRIMARY CARE
PROVIDER WHO HAS A CONTRACT WITH THE MANAGED CARE ORGANIZATION OR A
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- 3830 -
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