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S.B. 497 VETOES
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(2) RECORDS A RESERVE FOR THE LIABILITIES OF THE CONTRACTING
PROVIDER IN ACCORDANCE WITH § 5-201 OF THIS ARTICLE.
(b) (C) A health maintenance organization may not enter into an
administrative service provider contract unless:
(1) The health maintenance organization files with the Insurance
Commissioner a plan that satisfies the requirements of subsection (c) of this section;
and
(2) The Insurance Commissioner does not disapprove the filing within 30
days after the plan is filed.
(c) (D) The plan required under subsection (b) (C) of this section shall:
(1) Require the contracting provider to provide the health maintenance
organization with regular MONTHLY reports, at least quarterly WITHIN 30 DAYS OF
THE END OF THE MONTH REPORTED, 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 a current annual financial statement of the contracting
provider each year, WITHIN 90 DAYS OF THE END OF THE YEAR REPORTED;
(3) Require the creation by the [contracting provider, or on the
contracting provider's behalf,] HEALTH MAINTENANCE ORGANIZATION of TO
ESTABLISH AND MAINTAIN a segregated fund, IN A FORM AND AN AMOUNT
APPROVED BY THE COMMISSIONER, (which may include withheld funds, escrow
accounts, letters of credit, or similar arrangements), or require the availability of
other resources that are WHICH MAY INCLUDE WITHHELD FUNDS, ESCROW
ACCOUNTS, LETTERS OF CREDIT. OR SIMILAR ARRANGEMENTS. OR REQUIRE THE
AVAILABILITY OF OTHER RESOURCES THAT ARE sufficient to satisfy the contracting
provider's obligations to external providers for services rendered to members of the
health maintenance organization;
(4) Require an explanation of how THE CONTRACTING PROVIDER TO
SUBMIT TO THE HEALTH MAINTENANCE ORGANIZATION INFORMATION
DEMONSTRATING THAT the fund or resources required ESTABLISH under paragraph
ITEM (3) of this subsection create funds or other resources IS sufficient to satisfy the
contracting provider's obligations to external providers for services rendered to
members of the health maintenance organization; [and]
(5) [Permit] REQUIRE the health maintenance organization, 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; AND
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- 3914 -
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