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S.B. 497
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VETOES
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(2) The Insurance Commissioner or an agent of the Commissioner shall
examine the financial affairs and status of each managed care organization at least
once every 5 years.
19-712.
(b) (1) (I) [A] SUBJECT TO SUBPARAGRAPH (II) OF THIS PARAGRAPH, A A
person who holds a certificate of authority to operate a health maintenance
organization under this subtitle and who enters into any administrative service
provider contract, as defined in § 19-713.1 § 19-713.2 of this subtitle, with a person or
entity for the provision of health care services to subscribers shall be FINANCIALLY
AND ADMINISTRATIVELY responsible for all claims or payments for health care
services:
[(i)] 1. Covered under the subscriber's contract; and
[(ii)] 2. Rendered by a provider, who is not the person or entity
which entered into the administrative service provider contract with the health
maintenance organization, pursuant to a referral by a person or entity which entered
into the administrative service provider contract with the health maintenance
organization.
(II) THE FINANCIAL AND ADMINISTRATIVE RESPONSIBILITIES OF A
HEALTH MAINTENANCE ORGANIZATION UNDER AN ADMINISTRATIVE SERVICE
PROVIDER CONTRACT;
1. ARE NOT LIMITED BY THE VALUE OF THE ASSETS OF A
SEGREGATED FUND ESTABLISHED UNDER AN ADMINISTRATIVE SERVICE PROVIDER
CONTRACT;
2. EXIST IRRESPECTIVE OF WHETHER THE CONTRACTING
PROVIDER IS INSOLVENT; AND
3. EXIST IRRESPECTIVE OF ANY CONTRARY OR LIMITING
CONTRACT PROVISION.
(2) Responsibility for claims and payments under this subsection is
subject to the provisions of § 19-712.1 of this subtitle § 15-1005 OF THE INSURANCE
ARTICLE.
(C) THE RESPONSIBILITY OF A HEALTH MAINTENANCE ORGANIZATION FOR
CLAIMS OR PAYMENTS FOR HEALTH CARE SERVICES IN ACCORDANCE WITH
SUBSECTION (B) OF THIS SECTION UNDER AN ADMINISTRATIVE SERVICE PROVIDER
CONTRACT:
(1) IS NOT LIMITED BY THE AMOUNT IN A SEGREGATED FUND
ESTABLISHED UNDER § 19-713.2 OF THIS TITLE;
(2) EXISTS IRRESPECTIVE OF THE INSOLVENCY OR OTHER INABILITY
OR FAILURE OF A CONTRACTING PROVIDER, AS DEFINED IN § 19-713.2 OF THIS
SUBTITLE, TO PAY;
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- 3912 -
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